Remote Contractual Compliance Coordinator

Overview

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

In Short

• Conduct routine monitoring and audits of procedures.
• Ensure compliance with client contract criteria and requirements.
• Generate and submit required Commercial claims reporting.
• Prepare for annual Health Plan audits.
• Confirm pricing accuracy in fee tables.
• Monitor processes to detect fraud, abuse, or waste.
• Assist in auditing and submitting appeals and UM Challenges.
• Run access queries and impact reports as needed.
• Exercise independent judgment in significant matters.
• Other duties as assigned.

Requirements

• 3-5 years of experience in healthcare or managed care.
• 3 years of auditing experience in healthcare.
• CPT and ICD coding knowledge.
• Knowledge of Medicare requirements and APC Pricing.
• Proficiency in Microsoft Office products.
• Experience as an Internal Claims Auditor.
• Problem-solving and decision-making skills.
• Understanding of healthcare compliance requirements.
• Ability to meet deadlines and prioritize tasks.
• Effective communication skills.

Benefits

• Fully remote work environment.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan with employer match.
• Life and Disability insurance.
• Employee Assistance Program (EAP).
• Paid time off plans.
• Paid parental leave.
• Resources for professional growth and development.