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MemorialCare · 1 day ago

Compliance Coordinator

Fountain Valley, CA

Full-time

Hybrid

Mid Level

$35.46/hr - $51.46/hr

3+ years exp

MemorialCare is a nonprofit integrated health system committed to providing patient-centric and affordable healthcare. The Compliance Coordinator plays a vital role in managing and documenting compliance and regulatory activities, ensuring that all reports and tasks are completed in a timely manner.

ChildrenHealth CareHospitalMedicalNon Profit

Responsibilities

Completes weekly, monthly, quarterly, and yearly regulatory and compliance UM reports and requested files and submits using the health plans’ submission portals or secure email and maintains ongoing report submission log

Collaborates with the IT team to ensure that all primary health plans’ report templates are updated as needed to meet regulatory and health plan requirements

In partnership with the Compliance Manager. Prepares for UM delegation audits by, gathering evidentiary documents, UM referral files, and universe logs as requested by the health plans and submits timely

Conducts and monitors Utilization Management internal audits such as (TAT-Turnaround times and UM Member and Provider letter content updates) to stay in compliance with Utilization Management HICE, DHCS, DMHC and health plans’ regulatory requirements and provide audit findings to Compliance Manager

Ensures completion of annual UM Affirmative Statement & Confidentiality Agreement signed by all UM Staff and save in the sharedrive for annual audit purposes

Collaborates with the Director of Compliance and UM Manager to plan for the UM Committee meeting. Takes meeting minutes, records regulatory decisions, gets required approval signatures, and keeps the UMC attendance list up to date

Responds to all legal subpoena requests for medical records for UM referral denials, gathering documents to send to the health plans timely

Develops strong and collaborative working relationships with the health plan auditors and representatives

May be required to perform duties typically assigned to peers holding the same title to ensure continuity of department operation needs

As needed, works with other Compliance Coordinator as back-up in maintaining and monitoring the ongoing updates and compliance of all MCSHP delegated health plan member and provider letter templates and letter inserts to meet health plans and DHCS/DMHC requirements

Collaborates with the IT team for final Member/Provider letter template review prior to system production and creates CRM if necessary

Monitors and maintains the ongoing primary health plans requests log

Organizes and maintains filing systems and archival records within the shared drives. Saves all work files in the designated location in the sharedrive to be accessible at all times for the compliance team

Engages in cross-functional training to support ongoing operations and serve as back-up for team members when needed

Performs other compliance-related duties as assigned

Qualification

Utilization ManagementHealth Plan auditsClinical terminologyMicrosoft ExcelBachelor’s DegreeEPIC/TapestryMicrosoft PowerPointMicrosoft VisioHealthcare softwareAssociates Degree

Required

Minimum 3-4 years of medical management experience, especially in the area of Utilization Management and Health Plan audits

Knowledge of clinical and medical terminology

Advanced computer skills in a Microsoft Window environment, especially Excel and PowerPoint, as well as Visio and various healthcare software programs

Bachelor's Degree in Healthcare Administration or a healthcare related field of study

Or Associates Degree with extensive experience in medical management