Compliance Specialist I

Description

This position is 100% remote.

Quick Med Claims (QMC) is a nationally recognized leader in emergency medical transportation billing and reimbursement. QMC is committed to providing services in a manner that ensures compliance with all applicable billing and reimbursement regulations while maximizing the capture of allowable reimbursement for each client. The commitment to adherence to both principles make QMC the partner of choice for emergency medical transportation providers.

Summary

The Compliance Specialist I will be primarily responsible for regular auditing claims to verify compliance with regulatory and/or payor requirements and QMC policies. Responsible for completing documentation of internal and external audit results and reporting the information to the Compliance team and other QMC departments. Responsible for understanding and enforcing compliance with HIPAA privacy regulations and may also conduct privacy audits to identify and mitigate risk areas. Responsible to create and deliver educational materials when there are new or changed regulations/requirements or when targeted compliance training is needed. All members of the Compliance Department are responsible for helping to design and implement QMC’s governance, risk management and compliance efforts. Reports to the Compliance Manager.

Responsibilities

• Conducts audits on various aspects of the coding, billing, documentation and reimbursement to verify compliance with payor requirements and QMC policies.
• Monitors overall compliance throughout the claim reimbursement process.
• Updates department and related company policies to reflect changes in regulatory environment
• Conducts regular compliance meetings with internal groups, including management from Billing and Posting teams, and conducts educational trainings as needed for all QMC locations
• Provides F10 certification for new Billing Specialists Assists Billing Department with overflow workload when necessary
• Serves as a subject matter expert (SME) regarding billing & HIPAA privacy compliance and may participate on cross-functional teams and projects
• Has frequent contact with clients and assigned QMC staff, and attend client meetings as requested
• Assists with on-boarding new clients and identifies any new or special compliance requirements
• Assists in gathering and reviewing documentation for external audits and may prepare responses to auditors or regulatory agencies
• Helps implement QMC’s governance, risk management, document retention and compliance efforts
• Keeps updated on Federal, State, and Local government regulations and may research existing, pending or new legislation
• Attends workshops, seminars, and other training to maintain a high level of knowledge of the latest trends in healthcare reimbursement and privacy compliance.
  
  

Other Responsibilities

• Adhere to all QMC HIPAA privacy policies and procedures. This includes always maintaining the confidentiality and security of sensitive patient information.
• Ensures consistent adherence to company attendance policies.
  
  

Requirements

Qualifications:

• High School Diploma or equivalent required; Associates degree or equivalent preferred
• Minimum two years as a Billing Specialist with experience in healthcare
• Prior experience conducting audits or quality reviews is preferred
• Prior experience creating educational tools or training modules is preferred
• Emergency Medical Transportation Billing Industry experience preferred
• Certified Ambulance Coder (CAC) from NAAC preferred
• Proficient in Microsoft Office
• Strong Customer Service focus
• Ability to communicate effectively across the organization and with external parties such as clients, auditors, health insurance carriers, providers, etc.
• Ability to work collaboratively at all levels of the organization
• Strong time management skills and the ability to multi-task in a fast-paced environment
• Knowledge of a variety of insurance products and claims processing requirements, including federally funded programs like Medicare and Medicaid
• Knowledge of HIPAA privacy regulations
  
  

Benefits

• Comprehensive & competitive benefit package
• Generous 401k Company Match Program
• Profit Sharing Potential
• Bonus Program Potential
• Flexible work schedules
• Paid time off and holidays