Medical Management Compliance Specialist - Medical Management - Job Position #2019-171

MEDICAL MANAGEMENT COMPLIANCE SPECIALIST - MEDICAL MANAGEMENT (2 POSITIONS)- JOB POSITION #2019-171

Date Posted:
Classification:
Administrative
Type
Full Time
Location
OPEN UNTIL FILLED Redlands Monday - Friday 8:00a.m. - 5:00p.m.

Job Description

 

The Medical Management Compliance Specialist coordinates all Medical Management compliance activities with contracted health plans and regulatory entities such as CMS, DMHC, and DHCS. The Compliance Specialist has the primary responsibility for ensuring timely and accurate data is collected, validated, and submitted to various clients, providers, and health plans based on regulatory requirements and contractual agreements. The Compliance Specialist also coordinates all compliance auditing activities with the Compliance RNs, and all levels of Medical Management leadership.

 

Qualifications

 

High School diploma or equivalent. Bachelor’s degree or higher in health care related field preferred. Two years of broadly based, multi-tasking clerical/secretarial experience. Basic knowledge of data collection and validation process. At least two years of experience in a medical, managed care or health care setting. Possess a basic knowledge of CPT/ICD codes preferred.

 

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