UM Compliance Coordinator

Advanced Medical Management • Long Beach, CA

1d

About The Position

Reports to Compliance Manager. The Compliance Coordinator I, assisting and informing the Compliance Manager of any barriers that may preventing tasks from being completed in a timely and efficient manner. Individual must be able to execute effective communications verbally and in writing, maintain patient confidentiality, and promote departmental and organizational goals.

Requirements

• Two to Three years related experience and/or training; or equivalent combination of education and experience preferred
• High school diploma or GED, Bachelor degree preferred
• Must be able to communicate both orally and in writing.
• Ability to apply common sense, to read and comprehend simple instructions to carry out detailed written and/or oral instructions
• Must be able to efficiently prioritize multiple high priority tasks
• Must have the ability to work independently and be organized with minimal supervision
• Must maintain strict confidentiality of all patient information and IPA business

Responsibilities

• Monitors timeliness of the deferral process for all authorization referral requests and assists with acquiring additional information, including demographic and medical information
• Responsible for initial notification of the deferred status to the provider within 24 hours, and written notification to the member and provider with 72 hour of delay
• Responsible for initial notification of the denied status to the provider within 24 hours, and written notification to the member and provider
• Responsible for maintaining original copies of all deferred requests for submission for medical review after additional information is submitted
• Assist with denial process for all authorization referral requests that have been denied by the Medical Director, including attachment of denials in Cerecons
• Processes returned mail
• PCP notification of patient admissions and discharges
• Makes follow up calls for CCS application status
• Manage the Audit Manager application for UM issues per P&P
• Runs applicable reports for the department utilizing database system (Approvals, Denials, Carve-Outs and Deferrals.)
• Manage the claims reports in a timely manner
• Communicates with delegation oversight from the healthplan to conduct the audits and help with the requirements of the health plan
• Works on the “Corrective Action Plan” for the health plans and actively communicating with the various departments on the audit findings
• Must be familiar with the contents of AMM Policy and Procedures and laws and regulations relating to Coordinators
• Performs other duties as directed by Compliance Manager
• Maintain patient safety and privacy. Confidentiality is key
• Must be flexible, pleasant and willing to help patients in any way needed

Benefits

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED