Job Information
Tri-County Mental Health Services Compliance Specialist in Kansas City, Missouri
Compliance Specialist
Summary
Title: Compliance Specialist
ID: 5642
Department: Quality Improvement
Salary Range: N/A
Employment Status: Full-time
Description
POSITION SUMMARY
The Compliance Specialist works closely with the QI/Compliance Manager and is responsible for a variety of tasks to promote regulatory compliance.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:
• Reviews monitoring reports to determine possible areas of non-compliance; follows up with staff as necessary to correct errors.
• Provides back-up for documentation billing corrections ticket system.
• Provides technical assistance training on EMR system as needed as related to billing issues.
• Reviews weekly security audits to ensure compliance with agencies policies and procedures. Reports information to the QI/Compliance Manager.
• Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers who provide consumer care for the agency.
• Responsible for ensuring providers are credentialed with health plans.
• Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
• Coordinate with insurance companies to ensure practitioners are appropriately credentialed.
• Monitoring training requirements for credentialed staff/providers.
• Serves as a member of the Compliance Committee. Takes minutes at quarterly meetings and helps follow-up on outstanding items.
• Maintain knowledge of agency technology programs and/or systems needed to do the job and use them effectively.
• Other duties and/or responsibilities may be assigned by supervisor.
MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)
Education/Certifications:
High School diploma or equivalent required.
Experience:
1 to 3 years previous experience required
3 to 5 years previous experience preferred
Required Knowledge:
• Knowledge of electronic medical record systems
• Computer literacy with proficiency in Microsoft Office
• Prior credentialing experience strongly preferred
• Knowledge of federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting
Skills/Abilities:
• Ability to communicate effectively, both orally and in writing, to both internal and external customers.
• Ability to organize, develop, implement, monitor, and evaluate work plan goals and performance objectives.
• Ability to interpret and evaluate information
• Demonstrated ability to exercise independent judgment and to meet deadlines
