Compliance Coordinator

MemorialCare•Fountain Valley, CA

1d•$35 - $51•Hybrid

About The Position

The Compliance Coordinator is a key leadership support position designed to provide, manage, and document continuous compliance and regulatory activities within the department. This individual will be responsible for the ongoing monitoring and analysis of clinical performance, to assist in the design and implementation of improvement initiatives within medical management. This position is part of a compliance team, reporting to the Delegation Oversight & Compliance Manager, and works closely to ensure that all regulatory and compliance reports and tasks are completed in a timely manner.

Requirements

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

Nice To Haves

Experience in EPIC/Tapestry a plus.

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.