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Clinical Compliance Coordinator (Home Health - West Mifflin)

  • Job ID: 666279099
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Home Healthcare
  • Department: Compliance
  • Location: 1020 Lebanon Road, West Mifflin PA 15122
  • Union Position: No
  • Salary Range: $25.81 to $44.67 / hour

Description

UPMC Home Health is hiring a Clinical Compliance Coordinator! 

This is a Full Time position working Monday-Friday, 8A-430P. The office is located in West Mifflin.

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)
  • Act 34

  • 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 — 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.

   Current UPMC employees must apply in HR Direct