TalenTrust Workers Compensation Compliance Manager in Golden, Colorado
Equian is a leading provider of technology-enabled, data-driven solutions ensuring payment integrity across the healthcare and property and casualty industries. We seek to attract, develop and retain associates sharing our commitment to innovation, continuous improvement, superior service and professional curiosity.
This position is responsible for maintaining and monitoring HIPAA compliance within the Work Comp Bill Review/Rx offices, reviewing all workers compensation fee schedule updates and providing necessary communication/education to the Pharmacy and Bill Review Productions Managers/Team Leads, performing quality assurance audits for proper application of the fee schedules.
For all fee schedule updates/changes employee will be responsible for the following:
Verifying both pharmacy and bill review platforms have been updated via testing
Updating all employee reference material including, but not limited to E-Binder, State Licensing, Specialty Audit Master File, Facility Matrix, Out of State Provider document, etc.
Serve as liaison between software vendor partners regarding platforms as related to fee schedule rules/guidelines
Communicate/train staff regarding all regulatory changes
Research/understand current and proposed legislation, recommend new procedures as related to fee schedule changes
Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
Identify fee schedule application errors, provide employee education and monitor compliance as it relates to payment integrity.
Develop a workflow to communicate bill review errors to Bill Review Managers for employee education (retrospective Quality Assurance).
Responsible for researching and completing Bill Review Support Requests emails related to fee schedule issues
Maintain and monitor HIPPA compliance and report any HIPPA non-compliance to appropriate manager and Corporate Office
Education: Bachelor’s degree required
Preferred -at least one (1) coding credential (CPC, CPC-H, CCS, CCS-P)
Experience: Minimum of (5) years of work experience in the healthcare industry (pharmacy benefit management, clinical, provider billing, provider collections, insurance or managed care)
Workers Compensation industry experience preferred.
This position offers a competitive wage and benefit package.
TalenTrust works with rapidly growing, middle market companies who value their people. We are our client’s recruitment partner and identify exceptional talent to accelerate their growth. Unlike traditional staffing models, our recruitment process ensures full integration to capture a client’s culture and employment brand. We provide a personalized and collaborative value proposition to both the candidate and client.
Find out more about us by visiting our website www.TalenTrust.com.
TalenTrust and our partners are Equal Employment Opportunity (EEO) employers and welcome all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, or religion