Mercyhealth

Job Description:

A passion for making lives better.

Mercy Health System and Rockford Health System have joined forces to become Mercyhealth, a vertically integrated, not-for-profit multi-regional health system serving northern Illinois and southern Wisconsin. At Mercyhealth, we serve with a passion for making lives better. We hire well qualified individuals because we want our patients to get exceptional care, close to home. We are growing and expanding services because we want to make lives better by providing greater access to top-notch medical care for the communities we serve. We purchase the latest technology and pursue advanced accreditations and certifications because our patients deserve the very best health care has to offer.

We are seeking a talented individual to join us as a Compliance Coordinator – Insurance Operations for Mercyhealth, our wholly owned subsidiary that links Mercyhealth together by offering a complete continuum of health care services to our membership, including seniors, individuals, and area employers and their employees.

Compliance Coordinator – Insurance Operations

Position located in Janesville, WIPlan, organize, and execute compliance programs associated with insurance products marketed by MercyCare, including Medicare Advantage, Medicaid, Federal Employees Health Benefit program, Wisconsin Department of Employee Trust Funds, and the commercial products regulated by the Wisconsin Office of the Commissioner of Insurance and the Illinois Department of Insurance.

  • Use CMS audit protocols to develop and implement internal auditing activities and checklists.
  • Develop, implement and track metrics for each operational area, and create a consistent and regular reporting mechanism and process.
  • Develop educational training modules to ensure staff is knowledgeable about Medicare Fraud, Waste and Abuse, and internal policies and procedures.
  • Work with compliance officer to investigate issues reported to the compliance hot line.
  • Assist compliance officer with activities related to oversight of first tier, downstream and related entities.
  • As resource for MercyCare partners, maintain current knowledge of Medicare regulations and guidelines.
  • Assist staff in interpreting, understanding and applying regulations to operational activities.
  • Work with operational areas to ensure appropriate documentation of policies and procedures.
  • Perform monitoring activities based on the compliance plan developed by compliance officer, under the auspices of the Mercy Health System Compliance Committee, and create management reports accordingly.
  • Perform multiple analytical reviews of various data sources to validate data reported to CMS and ensure compliance with Medicare program requirements.
  • Proactively audit data sources—including cross-claims analysis using pharmacy and medical claims data—to find anomalies, and then perform investigations to explain and report findings.
  • Prepare management reports based on audits, monitoring and compliance issues reported or received.
  • Create reports and files to comply with regulatory reporting requirements, such as Medicare Secondary Payer, debarment and suspension.
  • Review CMS-generated memos and other government-issued communications to remain current on regulatory activity and help operational areas adopt and implement new requirements.
  • Work with compliance officer to manage regulatory audits.
  • Coordinate the development, updating and filing of plan documents for commercial insurance products, following state and federal regulatory guidelines.

Required Qualifications:

REQUIREMENTS

  • Bachelor’s degree from four-year college or university.
  • At least 1 to 2 years relevant experience or training (or equivalent combination of education and experience).
  • Knowledge and experience working with healthcare claims data in multiple formats.
  • Proficient with various data-analysis tools and software, as well as database, Internet, spreadsheet and word processing software.
  • Adept at solving practical problems and dealing with a variety of concrete variables in situations where only limited standardization exists.
  • Proficient in interpreting a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Excellent communication and analytical/interpretive skills, with high degree of accuracy.
  • Keen adherence to Mercyhealth’s high standards related to quality, service, partnering, cost, analysis, design, problem solving, project management, and technical skills.

 

In addition to opportunities to learn, grow, and advance, Mercyhealth offers health and dental insurance, vacation, matched retirement savings, and more. Apply online at:

MercyHealthSystem.org

EOE&AA/M/F/Vet/Disabled

PI99587284

Apply Online: http://www.MercyHealthSystem.org/Careers