What are the responsibilities and job description for the Compliance Coordinator position at Advanced Medical Manage?
Job Description
Job Description
POSITION SUMMARY
Reports to Compliance Manager. The Compliance Coordinator I, assisting and informing the Compliance Manager of any barriers that may prevent tasks from being completed in a timely and efficient manner. Individuals must be able to execute effective communications verbally and in writing, maintain patient confidentiality, and promote departmental and organizational goals.
RESPONSIBILITIES-DUTIES
- Monitors timeliness of the deferral process for all authorization referral requests and assists with acquiring additional information, including demographic and medical information
- Responsible for initial notification of the deferred status to the provider within 24 hours, and written notification to the member and provider with 72 hours of delay
- Responsible for initial notification of the denied status to the provider within 24 hours, and written notification to the member and provider
- Responsible for maintaining original copies of all deferred requests for submission for medical review after additional information is submitted
- Assist with denial process for all authorization referral requests that have been denied by the Medical Director, including attachment of denials in EZCap
- Processes returned mail
- PCP notification of patient admissions and discharges
- Makes follow up calls for CCS application status
- Manage the Audit Manager application for UM issues per P&P
- Runs applicable reports for the department utilizing database system (Approvals, Denials, Carve-Outs and Deferrals.)
- Manage the claims reports in a timely manner
- Communicates with delegation oversight from the health plan to conduct the audits and help with the requirements of the health plan
- Works on the “Corrective Action Plan” for the health plans and actively communicating with the various departments on the audit findings
- Must be familiar with the contents of AMM Policy and Procedures and laws and regulations relating to Coordinators
- Performs other duties as directed by Compliance Manager
- Maintain patient safety and privacy. Confidentiality is key
- Must be flexible, pleasant, and willing to help patients in any way needed
EDUCATION AND EXPERIENCE REQUIREMENTS
AMM BENEFITS
When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first :
