Transforming Healthcare through Compliance and Quality
At SCAN Group, a leading not-for-profit Medicare Advantage organization dedicated to improving the health and well-being of its members, we're on a mission to make a meaningful difference in the lives of seniors and individuals with disabilities. As a pivotal part of this endeavor, we're seeking a highly skilled and detail-oriented Network Compliance Coordinator - Clinical to support our Delegation Oversight Unit (DOU) in ensuring the highest standards of care and compliance within our provider network.
About the Role
The Network Compliance Coordinator - Clinical will play a critical role in facilitating audit activities, ensuring compliance with regulatory requirements, and fostering collaborative relationships with our provider offices. This position is not just a job; it's an opportunity to be at the forefront of healthcare compliance and quality assurance, making a tangible impact on the care and services provided to our members.
Key Responsibilities
- Educational Outreach: Conduct educational phone calls to provider office staff to prepare them for audits, ensuring they are well-informed and compliant with our audit processes.
- Clinical Collaboration: Partner with clinical staff to report audit findings, make recommendations to relevant committees, and develop corrective action plans to address any identified issues.
- Corrective Action Plan Management: Facilitate the timely closure of corrective action plans, ensuring that all necessary steps are taken to rectify compliance issues and improve care quality.
- Scheduling and Coordination: Manage multiple schedules effectively, utilizing scheduling software to streamline audit processes and ensure seamless coordination with provider offices.
- Stakeholder Communication: Maintain active and clear communication with managers, SCAN Auditors, and provider offices to ensure compliance with audit processes and address any concerns or issues promptly.
- Document Management: Track and trend documents related to Delegation Oversight Processes, including denial logs and Corrective Action Plans, to identify areas for improvement and ensure compliance.
- Compliance Support: Support the FDR Medicare Advantage Compliance program by collecting and monitoring attestations and conducting audits to ensure adherence to regulatory requirements.
- Customer Service: Provide exceptional internal and external customer service, adhering to SCAN Service Principles and ensuring a positive experience for all stakeholders.
- Process Improvement: Utilize department documentation to identify opportunities for improving efficiency and outcomes, contributing to the continuous enhancement of our compliance and quality assurance processes.
- Confidentiality: Maintain the confidentiality of provider networks, customers, and members' rights, upholding the trust and integrity that are foundational to our organization.
Essential Qualifications
To excel in this role, you will need:
- A minimum of 3+ years of experience in a healthcare or managed care environment, providing a solid foundation in the complexities of healthcare compliance and quality assurance.
- Proficiency in data entry, with the ability to accurately and efficiently manage and track relevant data.
- Demonstrated customer service skills, with a strong commitment to delivering exceptional service to both internal and external stakeholders.
- Excellent communication skills, both oral and written, to effectively interact with a diverse range of stakeholders, including provider office staff, clinical staff, and management.
- Strong organizational skills, with the ability to prioritize tasks effectively and manage multiple schedules and deadlines.
- The ability to multitask in a fast-paced environment, remaining calm and composed under pressure.
- Critical thinking skills, with the ability to analyze information, identify issues, and develop practical solutions.
Preferred Qualifications
While not mandatory, the following qualifications are highly valued:
- An Associate or Bachelor's degree, demonstrating a higher level of educational attainment.
- Medical Assistant certification, indicating specialized knowledge and training in healthcare.
- A comparable combination of education, experience, and/or training that is considered equivalent to the listed education requirements.
- Working knowledge of Medicare and Medi-Cal guidelines, providing a deeper understanding of the regulatory environment in which we operate.
Career Growth and Learning Benefits
At SCAN Group, we're committed to the growth and development of our employees. As a Network Compliance Coordinator - Clinical, you'll have access to a range of learning and development opportunities, enabling you to enhance your skills and advance your career. Our robust training programs, coupled with the chance to work on complex and challenging projects, will help you grow professionally and personally.
Work Environment and Culture
We pride ourselves on a culture that values collaboration, innovation, and integrity. As a remote worker, you'll be part of a dynamic and distributed team that is passionate about making a difference in healthcare. Our remote work mode offers the flexibility to work from anywhere, while our robust technology and communication tools ensure that you remain connected and engaged with your colleagues and the organization.
Compensation and Benefits
We offer a comprehensive compensation and benefits package that reflects our commitment to attracting and retaining top talent. This includes:
- A competitive hourly salary range of $23.50 to $37.60.
- A mostly remote work mode, offering flexibility and work-life balance.
- An annual employee bonus program, recognizing and rewarding your contributions to our success.
- A robust Wellness Program, supporting your physical and mental well-being.
- Generous paid-time-off (PTO), allowing you to recharge and enjoy time with family and friends.
- Eleven paid holidays per year, plus 1 floating holiday and 1 birthday holiday, giving you ample opportunity to celebrate and relax.
- An excellent 401(k) Retirement Saving Plan with employer match and contribution, helping you plan for a secure financial future.
- A robust employee recognition program, acknowledging your hard work and achievements.
- Tuition reimbursement, supporting your ongoing education and career development.
Join Our Team
If you're a motivated and detail-oriented professional looking to make a meaningful impact in healthcare compliance and quality assurance, we encourage you to apply for this exciting opportunity. As a Network Compliance Coordinator - Clinical at SCAN Group, you'll be part of a talented team dedicated to improving the lives of our members. Apply now and take the first step towards a rewarding new role that offers challenge, growth, and fulfillment.
Seize this opportunity to make a significant impact. Apply now and take the first step towards a rewarding new role.
Apply Now