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Contractual Compliance Coordinator
@Guidehealth
[Hiring] Contractual Compliance Coordinator @Guidehealth
Mar 26, 2025 - Guidehealth is hiring a remote Contractual Compliance Coordinator. 💸 Salary: $22.50 per hour. 📍Location: USA.
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Role Description
As a Contractual Compliance Coordinator, you will ensure the accuracy of the required reporting and procedural and financial claims processing requirements set forth by the client and Health Plan contract requirements for the Value Based Care lines of business. This position is responsible for regulatory and contract compliance in the managed care lines of business.
- Conduct routine monitoring and audits of procedures, including but not limited to billing systems audits, Encounter submission audits, and client audits.
- Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations.
- Generate and submit all required Commercial claims reporting.
- Play a vital role in preparing for the annual Health Plan audits.
- Confirm pricing is correct in the fee tables after the downloads are complete.
- Monitor internal and external processes to detect any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs.
- Participate in auditing and submitting appeals and UM Challenges for Reinsurance process.
- Run access queries and impact reports as needed for administrative purposes.
- Assist coworkers and Internal Auditors in additional compliance and auditing responsibilities, including pre-payment and post-payment audits.
- Consistently exercise independent judgment and discretion in matters of significance.
- Other duties and responsibilities as assigned.
Qualifications
- Minimum 3-5 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects.
- Minimum 3 years auditing experience in the healthcare industry.
- CPT and ICD coding knowledge.
- Knowledge of Medicare requirements and APC Pricing knowledge.
- Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access.
- Successfully function as an Internal Claims Auditor.
- Able to problem solve, exercise initiative and make medium to high level decisions.
- Thorough understanding of current federal, state and local healthcare compliance requirements.
- Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data.
- Ability to work independently with minimal supervision and as part of a team.
- Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player.
- Effective written and oral communication.
Requirements
- Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent in experience and education.
- Certified Professional Coder strongly recommended.
- Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus.
- Claim coding experience, coding edits experience and APC Pricing knowledge.
Benefits
- Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
- Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
- Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
- Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
- Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
- Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
- Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
- Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.
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| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
All others
All others
|
Salary
💸
$22.50 per hour
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 26, 2025
|
️
| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
