UM Compliance Coordinator

About the Role

Reports to the Compliance Manager. Responsible for UM reporting, audits, assisting with programing, and informing the VP, Operations of any barriers preventing timely and efficient task completion.

Key Responsibilities

• Schedules and prepares for CM/UM/QM audits
• Manages audit calendar and excel schedule
• Runs/Manages all reports as listed in the P&P
• Assists Compliance Manager, Quality Manager, and Director of Care Management to eliminate CAPs and/or operationalize process improvement techniques
• May assist with automating reports
• Maintains confidentiality of all members and medical/clinical information
• Performs duties as necessary for departmental changes, workload, and/or emergencies
• Understands Policies/Procedures
• Manages letter programs to ensure templates are accurate per Health Plan, including new and updated information from ICE Website
• Ensures the privacy and security of PHI (Protected Health Information) as outlined in AMM policies and procedures relating to HIPAA compliance
• Performs other duties as directed by Compliance Manager
• Provides back-up support for managing the Audit Manager application for UM issues
• Provides back-up support for creating denial letters with an 8th-grade language requirement

Requirements & Tech Stack

• Effective communication (verbal and written)
• Ability to apply common sense
• Ability to read and comprehend simple instructions
• Ability to carry out detailed written and/or oral instructions
• Ability to efficiently prioritize multiple high-priority tasks
• Ability to work independently and be organized with minimal supervision
• Strict confidentiality of all patient information and IPA business

Qualifications

• One year of experience in a physician office or clinic, or IPA/Group UM or CM department Coordinator is preferred.
• Individuals with a BA degree from a recognized university will be considered and trained.
• Medical terminology training, medical, or other healthcare-related experience is preferred.