Managed Care Coordinator

2 weeks ago

Quezon City, National Capital Region, Philippines Conifer Health Solutions Full time

Position Summary:

The Compliance Coordinator prepares for audits of delegated functions by health plan auditors. This position is responsible for submitting all health plan reporting and routine reports to regulators timely. The Compliance Coordinator provides support as needed to the claims department in the area of drafting corrective action plans (CAP) for audit reports about denial letters, in addition, performs limited internal audits under general direction of the Manager, Delegation Oversight Audit
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Job Duties and Essential Functions:

  1. Based on the audit sample, accurately obtain claim forms, attachments and all other documents, such as EOBs, bank statements, and denial
  2. Assembles all documents in logical sequence for external auditors to heighten perception of preparedness and enhance likelihood of positive audit
  3. Assists the claims management in drafting CAP responses by supplying working papers and other analysis.
  4. Based on the audit sample, obtains denial letters, deferral letters, print screens, attachments and all other documents in support of denial letters.
  5. Ability to follow a check list to assemble all documents in logical sequence for external auditors to heighten perception of preparedness and enhance likelihood of positive audit
  6. Assists the operations management in drafting CAP responses by supplying working papers and other
  7. Prepares and submits any supporting documentation that may be requested by the health plans
  8. Reviews submissions to identify any possible inaccuracies before documents are
  9. Submits UM denial letter packages to the health plans within the health plans' timely submission requirements
  10. Maintains compliance related correspondence from health plans in an organized and easy accessible
  11. Performs other work as directed by the Manager, Delegation Oversight Audits, claims operations, UM operations or compliance analyst
  12. Maintains and keeps in total confidence, all files, documents and records that pertain to the operation of business of Cap Management
  13. All other job related duties as it relates to the job function or as delegated by the management team.

Experience/Skills Requirements:

  • Excellent written and oral communication skills.
  • Highly proficient use or Microsoft Word, Excel, and Access. Familiarity with EZCap preferred.
  • Proficiency with Crystal or other report writing program preferred. At least 3 years of managed healthcare experience preferred

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