Compliance Specialist I
Company: North Coast Medical Supply LLC
Location: Carlsbad
Posted on: June 25, 2022
Job Description:
The Compliance Specialist I is responsible for assisting in
Medicare audits and appeals, and compliance with audit
requirements. The Compliance Specialist I will work within the
scope of responsibilities as dictated below with guidance and
support from our Operations and Compliance leadership
teams.ESSENTIAL FUNCTIONS
- Assists in Medicare audits and appeals
- Obtains information needed to ensure timely and accurate
completion of audits, and compliance with audit requirements
- Reviews medical records and billing-related documents
- Identifies discrepancies in patient records and/or
documentation
- Communicates with physicians' offices to obtain patient records
and all other information required by audit
- Audits beneficiary files
- Confirms patient eligibility standards
- Contacts patients to verify data as necessary or required
- Updates patient files
- Complies with HIPAA rules, appropriately safeguarding PHI or
other private and confidential information
- Adapts quickly to frequent process changes and
improvements
- Is reliable, engaged, and provides feedback as to improve
processes and policies
- Attends all department, team, and company meetings as
required
- Embraces and exemplifies ADS core values:
- We grow together
- We care
- We obsess over the customer experience
- We commit
- We WOW!OTHER RESPONSIBILITIESMay perform any additional
responsibilities or special projects as required. - Duties and
responsibilities may be subject to change based upon the needs of
the department.MINIMUM REQUIREMENTS
- High School diploma or equivalent
- Knowledge of insurance billing and processing claims
- Medicare claims and/or audit experience desired
- Familiarity with a variety of auditing & appeals processes and
procedures
- Familiarity with healthcare compliance issues, including HIPAA
privacy rules & requirements
- Proficiency in basic math and business calculations
- Working knowledge of computer/data entry with the ability to
learn new systems
- Basic level of MS Office proficiencyEXPECTED COMPETENCIES
- Friendly, professional and effective communications skills;
able to calmly present solutions in challenging situations
- Effective interpersonal skills
- Clear diction and knowledge of the English language, both
written and verbal
- Service-orientation and aptitude to resolve challenges with
audits and/or appeals
- Self-directed accountability and reliability
- Cultural competencePHYSICAL DEMANDSThe physical demands
described below are representative of those that must be met by an
employee to successfully perform the essential functions of this
job. Reasonable accommodations may be made to enable employees with
disabilities to perform the essential functions. While performing
the responsibilities of the job, the employee is required to remain
in a stationary position most of the time (stand or sit). While
performing the duties of this Job, the employee is regularly
required to sit; use hands to finger, handle, or feel; and talk or
hear. The employee is frequently required to stand, walk and reach
with hands and arms. The employee is occasionally required to
stoop, kneel, crouch, or crawl. The employee must occasionally lift
and/or move up to 15 pounds. Specific vision abilities required by
this job include close vision and ability to adjust focus.
OTHER REQUIREMENTSCandidates must successfully pass a background
check.
POSITION CLASSIFICATIONThis position is non-exempt. ADS/North Coast
Medical Supply is an equal opportunity employer. Candidates must be
able to provide proof of eligibility to work in the United States
without support; sponsorship is not available.
Keywords: North Coast Medical Supply LLC, San Diego , Compliance Specialist I, Other , Carlsbad, California
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