Corporate Compliance Specialist

Overview:

Provides support to the Compliance Supervisor, by maintaining internal and external audit schedules, assists in research of federal regulations regarding Medicare, Medicaid, and HIPAA. Participates in other compliance related duties as necessary or as determined by the Compliance Officer.Responsibilities:

Oversees Compliance Audit Plan
- Understand application of Medicare and Medicaid regulations regarding ambulance criteria and claims filing requirements.
- Effectively communicate Rural/Metro's Compliance Program requirements to both internal and external customers.
- Uses RAT-Stat sampling software to identify audit samples according to monthly audit plan.
- Able to complete an audit review and provide well developed audit documents including rationale of audit findings to billing and field operations personnel.
- Conducts diligence review audits as needed.
- Travel if necessary to complete on-site audits.

Process External Agency Audits
- Review external payor audit requests and work with billing centers and field operations to ensure complete and timely response.
- Review records requested by external agencies to determine any risks areas or non-compliance with regulations and communicate results to management in a timely manner.
- Provides assistance to field operations during on-site audits by state/federal agencies as needed.
- Ensures proper storage of audit materials.

Complete Appeals for Incorrectly Denied Claims
- Understand Medicare and/or Medicaid appeals process and ensure appeals are filed in accordance with regulatory deadlines.
- Apply Medicare and/or Medicaid regulations to denied claims to determine if an appeal is appropriate.
- Develop a clear and concise technical appeal rationale based on available regulations.
- Communicate need for medical necessity review with Medical Director.
- Track appeal activity and communicate status with billing center personnel.

Respond to Compliance Inquires
- Respond to all routine compliance inquiries in a timely manner or as set by department policy.
- Participate in compliance related investigations as necessary
- Knows when to ask for additional guidance or information

HIPAA Compliance
- Completes research regarding HIPAA regulations as needed.
Administrative Responsibilities
- Provide weekly compliance training status reports to designated field personnel
- Complete employee/vendor background checks as necessaryQualifications:

- Four years of Medicare, Medicaid, and third-party insurance related experience
- Familiar with medical terminology and coding (HCPC and ICD-9 Coding preferred)
- Ambulance related experience preferred
- HIPAA experience preferred
- Strong analytical problem solving and decision making skills
- Able to communicate with internal and external customers
- Proficient in Excel, Word, and PowerPoint applications
- Attention to detail
- Adaptable
Education Requirements:

- BA/BS Preferred
Rural/Metro is a proud Equal Opportunity employer, m/f/d/v.