Compliance Specialist
Reviews clinical medical records and claims for accuracy of services related to clinical standards of practice and care, levels of care, quality indicators, medical necessity, length(s) of stay, billing, and denials. Makes proposals related to compliance and continuous quality improvement. Conducts exit conferences and provides timely written feedback. Works collaboratively with Regional Operations and Site Managers. Participates in provider educational programs Serves as a resource, providing information generated from a sound basis Ensures confidentiality of medical information related to HIPAA regulations Displays dedication to corporate objectives. Performs audits as scheduled by the Compliance Leadership team. Assists with clinical review for issues investigation and resolution.
At least five years of clinical experience - Critical Care/Home Health Care preferred
Demonstrated knowledge of CPT, ICD-9 codes, DRGs, and APC coding
Understanding of payer rules and regulations, including Medicare and Medicaid
Risk Management
Time Management
MS Excel
MS Word
Nurse Management
CPUR certification
Multitasking
Process Improvement
Verbal communication
Detail Oriented
written communication
Self directed
According to JobzMall, the average salary range for a Compliance Specialist in 7227 Lee Deforest Dr, Columbia, MD 21046, USA is $56,000 to $76,000 per year. This range may vary depending on the employer and the candidate's experience and qualifications.
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Maxim Healthcare Services is a privately held medical staffing company headquartered in Columbia, Maryland that was founded in 1988 as MEDCALL Medical Staffing. In 2008, Maxim Healthcare received ACHC Accreditation.
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