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Compliance Specialist, Auditor in Phoenix, AZ at Preferred Homecare | LifeCare Solutions

Date Posted: 5/16/2018

Job Snapshot

  • Employee Type:
  • Location:
    Phoenix, AZ
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Provide advanced compliance assistance, auditing and specialized education as directed to internal clients with primary responsibility for all Government Payors.
Essential Duties and Responsibilities include the following:
  • Objectively audit government paid claims for line of business
  • Assist in responding to external government audits under direction from Asst. Director of Compliance and VP of Compliance
  • Complete appeals on audit denials
  • Support annual third party auditor for enterprise-wide audit as directed;
  • Support internal audit of commercial payers as directed;
  • Provide support for compliance software administration and all reporting and recordkeeping systems;
  • Ensure departmental files are kept up-to-date;
  • Tracking and coordination of metrics for all lines of business, including internal & external audit;
  • Coordination, research and notification of regulatory updates, state of emergency, and disaster reporting to all internal and external stakeholders, as well as tracking implementation of compliance related functions through a Regulatory Update Process;
  • Gather information to respond to regulatory matters, which may include regulatory audit requests, inquiry letters, comment letters, and applications;
  • Update and track Audit Plan as necessary;
  • Exclusion list tracking
  • Assist business units in the preparation and coordination of regulatory audits and coordination with Internal Audit;
  • Other projects and duties as assigned.
  • Associate or Bachelor’ Degree preferred with 3-5 years in health care compliance, healthcare billing and/or auditing
  • Significant experience with Medicare, DMEPOS, health care regulatory issues, including experience with health care fraud and abuse laws and regulations, Stark and Anti-Kickback Statute; licensure and certification, contracting, and the ability to understand and review claims documentation is required.
Computer Skills: To perform this job successfully, an individual should have Requires an excellent working knowledge of Microsoft Word, Excel, Adobe, and Outlook.