What are the responsibilities and job description for the Compliance Request Specialist-Mission Hills position at Providence?
Description
Compliance Request Specialist in Axminster Managed Care at Providence Medical Institute
Under general supervision performs responsibilities that demonstrate competency and knowledge in HMO/EPO/PPO UM Management. Has knowledge of Medicare, Medi-Cal, benefit coverages, Health Plan Appeals and Grievances; peer to peer process; medical criteria; criteria hierarchy, member reading grade levels. Understands HMO Referral Turn Around Time (TAT) guidelines; Federal, State and Health Plan regulations for extension, carve out, denial and approval letters; Health Plan audit requirements; dialysis requirements; Serves as a liaison between patients, hospitals, health plans, case managers, Request Specialists and Medical Foundations and Medical Groups. Responsible for verification of all needed information to issue all compliance notices; which include extension, carve out, denial, and alternative approvals for medical groups and lines of businesses.
Please upload a current resume reflecting all professional relevant experience.
Required qualifications:
- One (1) year of experience in a clinic, hospital or related health care industry in a managed care environment, or equivalent in education or medical certification in medical field (i.e. nursing, medical billing and coding, or medical admin assisting)
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
Providence Health & Services Southern California is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.
We offer a full comprehensive range of benefits — see our website for details — http://www.providenceiscalling.jobs/rewards-benefits
About Us
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Requsition ID: P364865
Company: Providence Jobs
Job Category: Patient Access
Job Function: Revenue Cycle
Schedule: Full time
Shift: Day
Career Track: Admin Support
Department: 7010 MSO OTHER CA TORRANCE 3
Address: CA Mission Hills 15451 San Fernando Mission Blv
