Remote Contractual Compliance Coordinator

Overview

The Remote Contractual Compliance Coordinator will ensure the accuracy of reporting and compliance with regulatory and contract requirements in the healthcare industry, focusing on managed care lines of business.

In Short

• Conduct routine monitoring and audits of procedures.
• Ensure compliance with client contract criteria.
• Generate and submit required Commercial claims reporting.
• Prepare for annual Health Plan audits.
• Confirm pricing accuracy in fee tables.
• Monitor processes for fraud detection.
• Assist in auditing and submitting appeals.
• Run access queries for administrative purposes.
• Exercise independent judgment in significant matters.
• Other assigned duties.

Requirements

• 3-5 years of experience in healthcare or managed care.
• 3 years auditing experience in healthcare.
• CPT and ICD coding knowledge.
• Knowledge of Medicare requirements.
• Advanced proficiency in Microsoft Office.
• Ability to problem solve and make decisions.
• Thorough understanding of healthcare compliance requirements.
• Ability to prioritize tasks and analyze data.
• Organized, detail-oriented, and professional.
• Effective communication skills.

Benefits

• Work from Home flexibility.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan with employer match.
• Life and Disability insurance.
• Employee Assistance Program (EAP).
• Flexible Time Off.
• Paid parental leave.
• Resources for professional growth.