Network Compliance Coordinator-Clinical
About the position
The position supports the Delegation Oversight Unit (DOU) at SCAN Group, focusing on facility site, medical record review, and utilization management audit activities. The role involves coordinating and tracking audits, conducting educational calls with provider staff, and ensuring compliance with audit processes. The individual will work closely with clinical staff to report findings and develop corrective action plans, while also managing multiple schedules and maintaining effective communication with various stakeholders.
Responsibilities
Provides educational phone calls to office staff at provider offices to prepare them for audits.
,
Partners with clinical staff to report findings and make recommendations to committees.
,
Facilitates the closure of corrective action plans within set time frames.
,
Manages multiple schedules and utilizes scheduling software effectively.
,
Communicates actively with managers, SCAN Auditors, and provider offices to ensure compliance with audit processes.
,
Tracks and trends documents related to Delegation Oversight Processes, including denial logs and Corrective Action Plans.
,
Supports the FDR Medicare Advantage Compliance program by collecting and monitoring attestations and conducting audits.
,
Provides internal and external customer service following SCAN Service Principles.
,
Utilizes department documentation to improve efficiency and outcomes.
,
Maintains confidentiality of provider networks, customers, and members' rights.
Requirements
3+ years of experience in a Healthcare or managed care environment required.
,
Proficiency with data entry is required.
,
Demonstrated customer service skills are essential.
,
Working knowledge of Medicare and Medi-Cal guidelines is preferred.
,
Ability to utilize critical thinking skills in decision-making processes.
,
Excellent communication skills, both oral and written, are necessary.
,
Strong organizational skills and the ability to prioritize tasks effectively.
,
Strong interpersonal skills and the ability to multitask in a fast-paced environment.
Nice-to-haves
Associate or Bachelor degree preferred, but not required.
,
Medical Assistant certification preferred.
,
A comparable combination of education/experience and/or training will be considered equivalent to the education listed.
Benefits
Base salary range: $23.50 to $37.60 per hour.
,
Mostly remote work mode.
,
Annual employee bonus program.
,
Robust Wellness Program.
,
Generous paid-time-off (PTO).
,
Eleven paid holidays per year, plus 1 floating holiday and 1 birthday holiday.
,
Excellent 401(k) Retirement Saving Plan with employer match and contribution.
,
Robust employee recognition program.
,
Tuition reimbursement.
Apply Now
The position supports the Delegation Oversight Unit (DOU) at SCAN Group, focusing on facility site, medical record review, and utilization management audit activities. The role involves coordinating and tracking audits, conducting educational calls with provider staff, and ensuring compliance with audit processes. The individual will work closely with clinical staff to report findings and develop corrective action plans, while also managing multiple schedules and maintaining effective communication with various stakeholders.
Responsibilities
Provides educational phone calls to office staff at provider offices to prepare them for audits.
,
Partners with clinical staff to report findings and make recommendations to committees.
,
Facilitates the closure of corrective action plans within set time frames.
,
Manages multiple schedules and utilizes scheduling software effectively.
,
Communicates actively with managers, SCAN Auditors, and provider offices to ensure compliance with audit processes.
,
Tracks and trends documents related to Delegation Oversight Processes, including denial logs and Corrective Action Plans.
,
Supports the FDR Medicare Advantage Compliance program by collecting and monitoring attestations and conducting audits.
,
Provides internal and external customer service following SCAN Service Principles.
,
Utilizes department documentation to improve efficiency and outcomes.
,
Maintains confidentiality of provider networks, customers, and members' rights.
Requirements
3+ years of experience in a Healthcare or managed care environment required.
,
Proficiency with data entry is required.
,
Demonstrated customer service skills are essential.
,
Working knowledge of Medicare and Medi-Cal guidelines is preferred.
,
Ability to utilize critical thinking skills in decision-making processes.
,
Excellent communication skills, both oral and written, are necessary.
,
Strong organizational skills and the ability to prioritize tasks effectively.
,
Strong interpersonal skills and the ability to multitask in a fast-paced environment.
Nice-to-haves
Associate or Bachelor degree preferred, but not required.
,
Medical Assistant certification preferred.
,
A comparable combination of education/experience and/or training will be considered equivalent to the education listed.
Benefits
Base salary range: $23.50 to $37.60 per hour.
,
Mostly remote work mode.
,
Annual employee bonus program.
,
Robust Wellness Program.
,
Generous paid-time-off (PTO).
,
Eleven paid holidays per year, plus 1 floating holiday and 1 birthday holiday.
,
Excellent 401(k) Retirement Saving Plan with employer match and contribution.
,
Robust employee recognition program.
,
Tuition reimbursement.
Apply Now