Schedule
Full-Time: Monday-Friday 8:00am- 4:30pm
SUMMARY
The Compliance Coordinator will play a critical role in ensuring compliance with billing regulations and maintaining the integrity of billing practices across all applicable programs. The Compliance Coordinator is responsible for interpreting regulations, conducting routine audits for Medicaid billing and developing and maintaining auditing tools that align with payer regulations. The Compliance Coordinator will implement systematic activities to ensure compliant billing, and support refunding of overpayments to governing authorities. Adherence to confidentiality standards, including 42CFR and HIPAA, is a key responsibility as is strong collaboration with internal teams, external agencies and the ability to manage multiple compliance-related tasks effectively.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Interpret regulations in order to apply to THRIVE Wellness and Recovery Inc. standards.
Perform routine audits of all Medicaid billing.
Develop and maintain auditing tools consistent with payer regulations.
Implement planned and systematic activities that will ensure compliant billing in all programs.
Attend team meetings as needed.
Educate and or train staff on details of payor billing requirement as requested.
Evaluate and monitor billing procedures to include practices related to the refunding of over payments to the appropriate governing authority or agency.
Review/investigate records in order to confirm quality of care, contact and accurate billing practices.
Assist manager with audits carried out by external agencies to include but not limited to: Medicaid, OASAS, OMH, CARF, Managed Care Plans.
Work collaboratively with OMIG in the event of an audit.
Participates in additional agency committees as assigned.
Promote, monitor and adhere to high level of confidentiality of 42CFR, HIPPA in record reviews.
Conduct orientation or training on various topics for employees as needed.
Other related duties as assigned.
Management has the right to add or change the duties of this position at any time.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Bachelor’s degree and two years of relevant experience in Human Services or Associate’s degree (A.A.S.) and four years of relevant experience in a Human Services Program. QMHS is beneficial but not required. Experience in QA is preferred.
