Compliance Coordinator

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS • Data

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

📋 Description

• Staff level position responsible for designated corporate-wide compliance activities in the areas of regulatory compliance and accreditation. • To support the designated activities of the Compliance Department. • To provide company-wide support in regulatory compliance and accreditation requirements. • To support all accreditation and regulatory filings as requested. • Assist with management of the corporate compliance program components as requested. • Provide timely updates and open communication with the Vice President, Chief Compliance Officer and Compliance Manager. • Assist with the provision of staff training on the subjects of regulatory compliance and accreditation standards and maintain documentation of all training. • Assist with management of the company Learning Management System as requested. • Support the review process for all corporate policies and procedures as requested. • Prepare and submit state and accrediting body filings, applications, and reports. • Prepare, submit, and review monthly exclusions checks on all employees and reviewer contractors. • Prepare, distribute, and present required compliance reports, submissions, etc., to regulatory and accreditation bodies. • Assist with providing employee and reviewer orientation and training/continuing education on operational processes regarding compliance with regulatory requirements and accreditation standards as requested. • Assist with internal and external audits conducted by or through the Compliance department and/or initiated by clients, outside agencies or regulators. • Gather, review, and analyze data required for such audits. • Assist with all follow up related to these audits, including internal reporting, monitoring and facilitating corrective action plans and process improvements. • Ensure compliance with Medicare Part D requirements and Fraud, Waste and Abuse policies. • Support legal concerns including but not limited to record requests, subpoenas, depositions, and releases of information as requested. • Assist with investigation and reporting of privacy and security incidents as requested. • Support all Quality Management initiatives as applicable. • Participate in the Complaint process as requested. • Maintain a flexible schedule. • Participate in all Company meetings and committees as requested. • Complete other duties and responsibilities as requested.

🎯 Requirements

• Exceptional customer service skills. • Exceptional analytical and critical thinking skills. • Excellent oral and written communication skills and interpersonal skills. • Exceptional orientation to detail. • Excellent organizational skills. • Ability to work under pressure and meet deadlines while managing multiple high priorities and maintaining a flexible schedule. • Strong working knowledge of managed care and utilization review accreditation standards, including URAC and NCQA, and multi-state regulatory requirements. • Thorough knowledge and understanding of the Company’s clients, products, departments and work flows. • Personal computer literacy and competency in use of Microsoft Word. • Competency in Microsoft Excel and Power Point preferred. • Ability to maintain a high level of objectivity and confidentiality. • Minimum of two years in healthcare, health insurance, and/or managed care arenas preferred. • Experience in compliance and/or quality improvement activities within a healthcare organization preferred. • Experience in providing small group or individual training preferred. • Experience in research beneficial and preferred.

🏖️ Benefits

• healthcare • vision and dental insurance • a generous 401k match • paid vacation • personal time • holidays • growth and training opportunities • team atmosphere with fun events and prizes scheduled throughout the year