Remote Managed Care Claims Compliance Coordinator

Overview

The Remote Managed Care Claims Compliance Coordinator will ensure the accuracy of reporting and compliance with procedural and financial claims processing requirements in the healthcare sector.

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 and abuse.
• Assist with auditing and submitting appeals.
• Run access queries and impact reports.
• Work independently and as part of a team.
• Other duties as assigned.

Requirements

• 3-5 years of experience in healthcare or managed care.
• 3 years auditing experience in healthcare.
• Knowledge of CPT and ICD coding.
• Understanding of Medicare requirements.
• Proficiency in Microsoft Office, especially Excel.
• Ability to problem solve and make decisions.
• Understanding of healthcare compliance requirements.
• Ability to prioritize tasks and meet deadlines.
• Effective communication skills.
• Organized, detail-oriented, and self-motivated.

Benefits

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