Healthcare Compliance Specialist

1. Equipment to be used by the temporary staffing professional(s) Computer; Phone

2. Computer software to be used: MS Office and Outlook

3. Interview Mode Personal

4. Knowledge, skills, education, and/or experience Experience with Computer and phone operations, Health Insurance.

5. Mandatory skills/certification(s) Requirement: Computer operations; Ms. Office; Phone operations; Customer Service

6. Desired skills: Pleasant personality; Interactive; Inclusive

7. Duties/Responsibilities: Health Care Compliance Specialist I - Admissions

1. Assist with the Admission Process of residents.

2. Assist in the determination of income, financial obligation, and eligibility of care (including health insurance).

3. Review and provide verification of health insurance status and eligibility of coverage of potential and existing residents.

4. Conduct a monthly audit of health insurance eligibility of existing residents in Ability or other healthcare insurance eligibility application.

5. Answer family members, potential residents’ calls, emails, and questions, regarding the Admission Process (including health insurance eligibility and coverage).

6. Assist in sending communications and status of the Admission Process (including health insurance) to family members and potential residents.

7. Assist in filing and maintaining health insurance information of potential, current and deceased residents.

8. Assist family members, potential residents in changing and updating health insurance coverage that best meet the needs of the resident.

9. Maintain and submit memos to other nursing home units (Nursing, Social Service, Pharmacy and Business Office) regarding health insurance coverage of admitted and current residents.

10. Manage resident accounts with contact information, insurance, and financial information in a confidential manner.

11. Schedule potential resident’s admission date to the nursing home.

12. Assist family members, potential residents’ in completing paperwork for the Admission Process.

13. Educate family members, potential residents about their health insurance options and the Admissions Process of the nursing home.

14. Ability to discuss or answer the basic financial obligation questions, which include but not limited to the following with the family members and potential residents:

a. Cost of Service

b. Insurance Eligibility and Coverage

c. Payment Options

d. Refer to Residents Account Office when necessary.

15. Scan applicable documents into resident’s chart(s) or file(s) as necessary.

16. Ensure compliance with professional standards & regulatory requirements.

17. Keep up to date with the latest trends in health care by attending seminars and sharing this information with the team.

18. Assist in the managing and distribution of the Letters for facility’s residents.

Prior Authorization Responsibilities:

19. Receives a request from Skilled Nursing or Physical Therapy for the Business Office to contact resident’s health insurance company to review eligibility and determine if a prior authorization is needed.

20. If prior authorization is needed, receive completed prior authorization form and information (CPT codes, diagnostic codes, medical documentation, clinical information to support medical services being requested) from Skilled Nursing and Physical Therapy

21. The Business Office will compile the prior authorization medical documentation and submit it to the resident’s health insurance company for review and approval.

22. If an extension on prior authorization is needed

Job Type: Contract

Pay: Up to $27.78 per hour

Schedule:

• 8 hour shift

Experience:

• Compliance management: 1 year (Preferred)

Ability to Commute:

• Paramus, NJ 07652 (Required)

Ability to Relocate:

• Paramus, NJ 07652: Relocate before starting work (Required)

Work Location: In person

Salary : $28