Compliance Coordinator

This is a fully remote position, open to applicants in Florida, +6 more states.

📋 Description

• Assists in ensuring that our services adhere to the highest standards of compliance with both government and commercial payer requirements.

• Conducts audits of medical documentation that supports claims submitted to government and commercial payers.

• Reviews documentation for accuracy, completeness, and conformity with payer guidelines.

• Analyzes payer contracts, fee schedules, databases, and system setup requirements.

• Identifies trends in audits, variances, deficiencies, and potential compliance risks.

• Prepares comprehensive audit reports and communicates findings to relevant stakeholders.

• Performs follow-up audits to verify the completion of corrective actions.

• Assists in the development and maintenance of compliance policies, procedures, audit standards, and reports.

• Acts as a resource for inquiries related to billing, reimbursement, documentation, and coding.

• Keeps updated with Medicare, Medicaid, and commercial payer rules and regulations.

• Collaborates with internal teams to address billing and documentation issues.

• Develops and conducts training related to billing and documentation expectations.

⛳️ Requirements

• A bachelor's degree is preferred, or an equivalent combination of education, training, and relevant experience.

• A minimum of 12 years of experience in healthcare compliance, billing, reimbursement, auditing, documentation review, revenue cycle, DME, home care, or a related healthcare environment is preferred.

• Experience in healthcare compliance or auditing is required.

• Background in DME, home infusion, respiratory, pharmacy, or pediatric healthcare is advantageous.

• Proficiency in advanced Excel skills is necessary.

• Experience in reviewing documentation for medical necessity and payer compliance is essential.

• Understanding of Medicare and Medicaid regulations is required.

• Experience in preparing audit findings, corrective action summaries, or training materials is preferred.

• Strong comprehension of medical documentation, payer requirements, billing support, and compliance standards is needed.

• Capability to read, interpret, and apply payer guidelines, contracts, fee schedules, policies, procedures, and governmental regulations is important.

• Excellent analytical abilities with a knack for identifying patterns, trends, variances, and compliance risks are required.

• Exceptional attention to detail and the ability to manage multiple audits, reports, and follow-up tasks is crucial.

• Strong written and verbal communication skills, including the capacity to present findings clearly to leadership and internal teams, are necessary.

• Proficiency in Microsoft Excel is essential; advanced Excel skills are strongly preferred.

• Experience with database maintenance, reporting, or system audits is preferred.

• Knowledge of Medicare, Medicaid, third-party payer reimbursement, coding, and documentation requirements is preferred.

• Ability to work independently, solve problems, and collaborate cross-functionally with billing, operations, reimbursement, and compliance teams is important.

🏝️ Benefits

• Holiday Pay

• Paid Time Off

• Health and Dental insurance

• Short & Long-Term Disability and Life Insurance

• 401K with match & educational benefits