Compliance Coordinator

🔥 0 minutes ago

🐊 Florida, Illinois, +5 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote ❄️ Minnesota – Remote 🤠 Texas – Remote 🧀 Wisconsin – Remote

💵 $30 / hour

⏰ Full Time

🟠 Senior

🔴 Lead

🚔 Compliance

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Pediatric Home Service

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1990

⚕️ Healthcare Insurance

Healthcare Insurance • Healthcare • Home Care

Pediatric Home Service is dedicated to providing specialized care for children with medical complexities in the comfort of their homes. Their mission focuses on offering a range of services, including respiratory therapy, clinical nutrition, infusion nursing, and durable medical equipment to support the health and wellbeing of pediatric patients. By ensuring that children can thrive at home, Pediatric Home Service also enables parents and caregivers to focus on family, enriching the lives of children with serious health challenges.

📋 Description

• Ensure our services meet the highest standards of compliance with government and commercial payer requirements. • Audit medical documentation supporting claims billed to government and commercial payers. • Review documentation for accuracy, completeness, and alignment with payer guidelines. • Analyze payer contracts, fee schedules, databases, and system set-up requirements. • Identify audit trends, variances, deficiencies, and potential compliance risks. • Prepare clear audit reports and communicate findings to appropriate stakeholders. • Conduct follow-up audits to confirm corrective actions have been completed. • Assist with development and maintenance of compliance policies, procedures, audit standards, and reports. • Serve as a resource for billing, reimbursement, documentation, and coding-related questions. • Stay current with Medicare, Medicaid, and commercial payer rules and regulations. • Partner with internal teams to resolve billing and documentation concerns. • Prepare and deliver training related to supported billing and documentation expectations.

🎯 Requirements

• Bachelors degree preferred, or equivalent combination of education, training, and related experience. • 12 years of experience in healthcare compliance, billing, reimbursement, auditing, documentation review, revenue cycle, DME, home care, or a related healthcare setting preferred. • Healthcare compliance or audit experience. • DME, home infusion, respiratory, pharmacy, or pediatric healthcare experience. • Advanced Excel skills. • Experience reviewing documentation for medical necessity and payer compliance. • Knowledge of Medicare and Medicaid regulations. • Experience preparing audit findings, corrective action summaries, or training materials. • Strong understanding of medical documentation, payer requirements, billing support, and compliance standards. • Strong analytical skills with the ability to identify patterns, trends, variances, and compliance risks. • Excellent attention to detail and ability to manage multiple audits, reports, and follow-up items. • Strong written and verbal communication skills, including the ability to present findings clearly to leadership and internal teams. • Proficiency with Microsoft Excel; advanced Excel skills strongly preferred. • Experience with database maintenance, reporting, or system audits preferred. • Knowledge of Medicare, Medicaid, third-party payer reimbursement, coding, and documentation requirements preferred. • Ability to work independently, problem-solve, and partner cross-functionally with billing, operations, reimbursement, and compliance teams.

🏖️ Benefits

• Holiday Pay • Paid Time Off • Health and Dental insurance • Short & Long-Term Disability and Life Insurance • 401K with match & educational benefits