Description
Who We Are - Motivated by Purpose. Powered by Clinical Expertise.
Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.
Excellence starts with our people.
WE OFFER
A competitive compensation package.
Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
Growth and training opportunities.
A team atmosphere with fun events and prizes scheduled throughout the year.
POSITION OVERVIEW
Staff level position responsible for designated corporate-wide compliance activities in the areas of regulatory compliance and accreditation.
Roles:
To support the designated activities of the Compliance Department.
To provide company-wide support in regulatory compliance and accreditation requirements.
To support all accreditation and regulatory filings as requested
Major Responsibilities or Assigned Duties:
Assist with management of the corporate compliance program components as requested.
Provide timely updates and open communication with the Vice President, Chief
Compliance Officer and Compliance Manager.
Assist with the provision of staff training on the subjects of regulatory compliance and accreditation standards and maintain documentation of all training. Assist with management of the company Learning Management System as requested.
Support the review process for all corporate policies and procedures as requested.
Prepare and submit state and accrediting body filings, applications, and reports.
Prepare, submit, and review monthly exclusions checks on all employees and reviewer contractors.
Prepare, distribute, and present required compliance reports, submissions, etc., to regulatory and accreditation bodies.
Assist with providing employee and reviewer orientation and training/continuing education on operational processes regarding compliance with regulatory requirements and accreditation standards as requested.
Assist with internal and external audits conducted by or through the Compliance department and/or initiated by clients, outside agencies or regulators. Gather, review, and analyze data required for such audits. Assist with all follow up related to these audits, including internal reporting, monitoring and facilitating corrective action plans and process improvements.
Ensure compliance with Medicare Part D requirements and Fraud, Waste and Abuse policies
Support legal concerns including but not limited to record requests, subpoenas, depositions, and releases of information as requested.
Assist with investigation and reporting of privacy and security incidents as requested.
Support all Quality Management initiatives as applicable.
Participate in the Complaint process as requested.
Maintain a flexible schedule.
Participate in all Company meetings and committees as requested.
Complete other duties and responsibilities as requested.
Requirements
Skills and Experience:
Exceptional customer service skills.
Exceptional analytical and critical thinking skills.
Excellent oral and written communication skills and interpersonal skills.
Exceptional orientation to detail.
Excellent organizational skills.
Ability to work under pressure and meet deadlines while managing multiple high priorities and maintaining a flexible schedule.
Strong working knowledge of managed care and utilization review accreditation standards, including URAC and NCQA, and multi-state regulatory requirements.
Thorough knowledge and understanding of the Company’s clients, products, departments and work flows.
Personal computer literacy and competency in use of Microsoft Word. Competency in
Microsoft Excel and Power Point preferred.
Ability to maintain a high level of objectivity and confidentiality
Minimum of two years in healthcare, health insurance, and/or managed care arenas preferred.
Experience in compliance and/or quality improvement activities within a healthcare organization preferred.
Experience in providing small group or individual training preferred.
Experience in research beneficial and preferred
Education:
High School Diploma
Preference for a Bachelor’s degree
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Work Environment:
Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).
Diversity Statement:
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
Drug-Free Workplace:
This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.
California Consumer Privacy Act (CCPA) Information (California Residents Only):
Sensitive Personal Info
: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
Data Access and Correction:
Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at [email protected].