Description
UPMC Home Health is hiring a Clinical Compliance Coordinator to join its team!
This is a Full Time position working Monday-Friday, 8A-430P.
Join the team that’s providing the highest quality of home health care in our communities. With state-of-the-art safety protocols and the support of an academic medical center, UPMC Senior Services has demonstrated a continued commitment to keeping both our residents and our employees safe and healthy, especially throughout the COVID-19 pandemic.
Make a true impact in your community where you’ll have the confidence that your care is clinically backed by a best-in-class health care system and the rewarding knowledge that you are changing lives every day.
Responsibilities:
- Provide on-going education related to audit results, compliance issues and HIPAA.
- Actively participatie in HHABN and NOMNC reviews.
- Assist with oversight of all external medical record requests.
- Initiate and facilitate the process of reconsideration for potential reversal of denial payment determinations.
- Identify, develop and participate in process improvement opportunities within the home health agency that will enhance the quality of the services we provide.
- Ensure completion of clinical compliance audit processes from internal and external sources.
- Focus on customer service and continually strive to perform the duties of job in a manner that results in optimal patient satisfaction.
- Represent at ALJ hearings as necessary.
- Support utilization functions with review and recommendations and provide on-going ADR education.
- Attend compliance training and adhere to the organization standards of conduct, policies and procedures.
- Develop, implement, perform and monitor audit activities to maintain agency compliance with fiscal and regulatory bodies.
- Provide coordination, final review and submission to the appropriate sources.
- Participate as ad hoc member on committees.
- Perform duties and job responsibilities in a fashion which coincides with the service management philosophy of UPMC towards patients, visitors, staff, peers, physicians and other departments within the organization.
Qualifications
- Graduate of an accredited school of professional nursing required.
- BSN, MSN preferred.
- Two (2) years experience in home health required.
- Demonstrated knowledge and proficiency in handling Medicare, Medicaid and commercial insurance regulations in order to maximize reimbursement.
Licensure, Certifications, and Clearances:
- Registered Nurse (RN)
- UPMC is an Equal Opportunity Employer/Disability/Veteran
Total Rewards
More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.
Our Values
At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.
