Compliance Coordinator

About Us

All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, vacation time, birthday time off as well as a 401k plan. Additional employee paid coverage options available.

Job purpose

The Compliance Coordinator assists the Compliance Department by preparing, reviewing and evaluating compliance files and privacy issues/concerns within the organization. This position also serves as the main ACTY Letter App resource and maintaining all letter template and attachments in coordination with the health plans. Provides administrative support to the compliance department, including reporting, communication, audit file coordination, etc.

Duties and responsibilities

• Responsible for preparing claims, utilization management, and general compliance files. Reviews files for inconsistencies and quality assurance prior to submission.
• Coordinate and submit weekly, bi-weekly, monthly, quarterly, semi-annual, annual, and ad-hoc reports for all health plans.
• Maintain master compliance reporting spreadsheet with regards to health plan compliance reporting templates and submission notes
• Develop, initiate, maintain, and revise compliance policies and procedures and job aids regarding the general operation of the Compliance Program including reporting, audit processes, and meeting coordination.
• Collaborates with other committees (e.g., UM Committee, Claims committee, Internal Audit, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution.
• Coordinate with Healthcare Information Technology team on compliance reporting and/or audit related deliverables, tickets, and process improvement.
• Coordinate compliance activities with other departments and sources as necessary.
• Maintains tracking logs and systems for uniform handling of compliance violations.
• Maintain Compliance email, communication with health plans regarding audits, reporting, deadlines, and ad-hoc requests.
• Maintain detailed tracking log of all compliance Hotline activity.
• Assist and coordinate ACTY’s response to audits (Corrective Action Plan follow up) by coordinating with Claims and Care Management teams to assure that appropriate actions are taken to resolve any problems.
• Serve as a back-up for the ACTY Letter App Management
• Assist the Compliance Committee activities, calendar, developing appropriate agendas, reports and information as requested by the committee.
• Assist with the development of Corrective Action Plans (CAPs) for regulatory agencies.
• Perform other related duties as assigned.

Qualifications

• Bachelor’s Degree, relevant experience in lieu of degree.
• 2 years’ experience within a healthcare administration organization.
• Ability to work independently as well as contribute to a positive team atmosphere.
• Authorization and Claim processing understanding preferred.
• EZ-Cap experience preferred.
• Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe.
• Detail oriented and highly organized.
• Strong ability to multi-task, project management, and work in a fast-paced environment.
• Strong ability in problem-solving.
• Ability to self-manage, strong time management skills.
• Ability to work in an extremely confidential environment.
• Strong written and verbal communication skills.