Provider Compliance Specialist

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$19.00/hr - $26.00/hr

Responsible for all activities related to order compliance and management of physician data in system(s); this position assures optimal regulatory compliance.

• Monitor orders which are in Mosai exception folder and perform necessary follow‑up.
• Assist Medical Records staff as needed with indexing of orders.
• Provide education and support to MR staff as it pertains to Mosai orders indexing, to ensure timely and appropriate follow‑up.
• Review orders to ensure compliance and follow‑up on issues identified until resolved, including but not limited to missing or wrong level signatures, incorrect address, missing dates, etc.
• Communicate with clinical field staff and supervisors as needed regarding assistance required to resolve orders issues. Notify clinical staff of any changes MDs have made to orders which could possibly affect the patient’s care.
• Monitor orders approaching 30‑day compliance and perform necessary follow‑up. Document all actions taken to ensure compliance with internal policies and DOH regulations.
• Update MD preference list, which includes MD special requests, and ensure orders are in accordance with this list.
• Verify physician credentials including: licensing, NPI, PECOS, OPRA, and OMIG/OIG/GSA sanctions, for new MDs. Verify MD licensure monthly, including researching any expiration and other issues identified, and update system accordingly.
• Monitor and maintain add/change physician workflow, including physician adds, demographics, and changes in corresponding orders as needed.
• Monitor and maintain add/change facility workflow, including facility additions and changes in facility addresses.
• Mail, track, and file signature attestation letters for new MDs.
• Perform audit of MD signatures per Corporate Compliance workplan.
• Communicate regularly with manager to ensure maximum compliance with orders for optimal regulatory compliance.
• Other duties as assigned.

In lieu of degree, at least 2 years experience with Medical Records in a health care setting with a full understanding of Medical Records Specialist role.

• Knowledgeable in medical order compliance.
• Demonstrated ability to apply critical thinking related to order compliance.

The Provider Compliance Specialist is primarily in an office setting and may be exposed to outdoor conditions.

Sedentary work classification:
Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

• Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

• Stand
• Sit
• Hear
• Walk
• Talk
• Stoop or kneel
• Repetitive motion

EOE/AA Minority / Female / Disability / Veteran

Entry level

Full-time

Finance and Sales

Hospitals and Health Care