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ASSIGNMENT SUMMARY
The Compliance Coordinator will be an active member of the Compliance and Credentialing teams, which includes the CAO, HR & Compliance Director, Compliance Manager and selected clinic staff. Will be responsible for maintaining current knowledge of relevant compliance requirements, clinic operations and managed care programs. Must be highly proficient in Microsoft Office programs and other computer functions in order to maintain detailed records.
ESSENTIAL FUNCTIONS/RESPONSIBILITIES
• Develop and maintain policies and procedures related to compliance with federal, state, and local regulations.
• Conduct regular audits to assess compliance with healthcare laws, regulatory standards, and internal policies.
• Provide training to staff on compliance requirements and best practices.
• Investigate complaints and alleged violations, and take appropriate corrective action.
• Collaborate with clinic leadership to develop strategies for maintaining compliance and reducing risk.
• Keep abreast of changes in healthcare regulations and disseminate relevant information to staff.
• Serve as the primary point of contact for external agencies and auditors during compliance audits and reviews.
• Monitor and track compliance indicators to ensure the clinic's adherence to standards.
• Garner & maintain knowledge of Health Plan compliance requirements, medical group operations, and medical terminology
• Work with the training and development staff to deliver and update training documentation, ensuring comprehensive understanding and adherence to compliance protocols.
• Develop and conduct training relating to emergency management and risk management.
• Create and deliver reports and presentations highlighting findings, identifying and explaining potential risks, and recommending solutions.
• Troubleshoot patient care issues, complaints and formal grievances with health plans.
• Provide educational information in conjunction with direct care providers related to treatments, procedures, medications, and continuing care requirements
• Coordinate Provider Credentialing and Re-Credentialing with Health Plans to meet all HRSA and state regulatory agency requirements
• Collaborate with the clinical staff to ensure high quality service
• Assist with Survey Requests
• Evaluate outcomes of care with the interdisciplinary team by measuring intervention effectiveness with the team; implementing team recommendations.
• Other duties as assigned & necessar