Provider Compliance Specialist

Role and Responsibilities 

Responsible for all activities related to order compliance and management of physician data in system(s); this position assures optimal regulatory compliance. 

Essential Functions 

• Monitor orders which are in Mosai exception folder and perform necessary follow-up.  


• Assist Medical Records staff as needed with indexing of orders. 


• Provide education and support to MR staff as it pertains to Mosai orders indexing, to ensure timely and appropriate follow-up. 


• Review orders to ensure compliance and follows-up on issues identified until resolved, including but not limited to missing or wrong level signatures, incorrect address, missing dates, etc. 


• Communicate with clinical field staff and supervisors as needed regarding assistance needed to resolve orders issues. Notify clinical staff of any changes MDs have made to orders which could possibly affect the patient’s care.  


• Monitor orders approaching 30 -ay compliance and perform necessary follow-up. Document all actions taken to ensure compliance with internal polices and DOH regulations. 


• Update MD preference list, which includes MD Special requests, and ensure orders are in accordance with this list. 


• Verify physician credentials including: licensing, NPI, PECOS, OPRA, and OMIG/OIG/GSA sanctions, for new MDs. Verify MD licensure monthly, including researching any expiration and other issues identified, and Update system accordingly. 


• Monitor and maintain add/change physician workflow, including: physician adds, physician demographics, as well as changes in corresponding orders as needed. 


• Monitor and maintain add/change facility workflow, including facility additions and changes in facility addresses. 


• Mail, track, and file signature attestation letters for new MDs. 


• Perform audit of MD signatures per Corporate Compliance workplan. 


• Communicate regularly with manager to ensure maximum compliance with orders for optimal regulatory compliance.  


• Other duties as assigned. 

This job description reflects management’s assignment of essential functions; and nothing in this herein restricts management’s right to assign or reassign duties and responsibilities to this job at any time. 

Education Requirements 

• Associate’s degree required.  

Qualifications and Requirements 

• In lieu of degree, at least 2 years experience with Medical Records in a health care setting with a full understanding of Medical Records Specialist role. 


• Knowledgeable in medical order compliance. 


• Demonstrated ability to apply critical thinking related to order compliance. 

Work Environment 

The Provider Compliance Specialist is primarily in an office setting and may be exposed to outdoor conditions. 

The working conditions are classified as sedentary work: 

• Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. 

Physical Requirements 

The following is a description of the physical requirements on a daily basis for the Provider Compliance Specialist. While performing the duties of the job the employee is regularly expected to: 

• Stand 


• Sit 


• Hear 


• Walk 


• Talk 


• Stoop or kneel 


• Repetitive motion 

This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned. 

EOE/AA Minority / Female / Disability / Veteran