Job Description

Compliance Specialist

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Work Location: Remote

Work Hours: Flexable- Can be 4- 4hour days or two 8 hour days

RESULTS DESCRIPTION:

Manages a database of certifications, credentials, and continuing education and requirements for Radiologists reading images according to MQSA and ACR standards. Plan, organize and coordinate credentialing activities. Communicate with payors to ensure that physicians are on contracts.

RESULTS MEASURED BY THE FOLLOWING RESPONSIBILITIES:

· Resolves credentially issues through proactive measures and follow through.

· Researches and verifies on engagement, the competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, health care affiliations, work history, military experiences, professional references, licensure and certifications, DEA certificates, malpractice coverage and privileges the applicant is requesting according to MQSA requirements

· Confirms in the OIG database, queries the National Practitioner Data Bank at start of engagement

· Ensures process of attestation is in place after Queries the Counsel for Affordable Healthcare (CAQH) database at the start of engagement, and manages expiring documents as appropriate

· Serves as the sole Manager for the credentialing database assuring accuracy and completeness

· Acts as a liaison between the various Radiology Groups and Solis (and its affiliates) to provides assistance in the coordination of the credentialing dates and times for new placements

· Facilitate physician onboarding with Manager of Clinical Training.

· Establishes a working knowledge of the regulatory MQSA and ACR requirements, compliance standards, State and Federal Law pertaining to the Radiologists and apply them to the credentialing process as needed

· Perform OIG Exclusion checks on all Radiologists, Vendors and Referring physicians monthly

· Create and maintain relationships with Medical Director, physician groups, center directors, regional operations directors and VPs of Operations.

· Manages compliance requirements through maintaining MQSA and ACR Certifications for all center locations

· Managers compliance requirements through maintaining insurance documents for all center locations and distribute to center directors

· Distribute MQSA and ACR notices to Director of Quality for follow up and assist in coordinating the effort for investigation

· Liaison with Billing company to ensure that Radiologists are contracted with various payors

· Liaison with Billing company to provide update, legal names, demographic information and national provider numbers for all joint ventures to ensure that they are amended on billing contracts.

· Upholds HIPAA regulations

· Other related responsibilities as required

· Understands, promotes and demonstrates the Solis Way

SKILLS/QUALIFICATIONS:

· Bachelor's degree or equivalent experience preferred.

· Two or more years of credentialing experience working with NCQA standards.

· Minimum of two years of experience in a centralized credentialing office or related health care environment, such as credentialing or file maintenance, preferred with experience in Word and Excel.

· At least two years of data entry experience.

· Working knowledge of managed care and/or credentialing.

· Must be highly organized with meticulous attention to detail for accuracy and completeness of records.

· Must have excellent verbal and written communication skills.

· Work well under pressure with little supervision and juggle multiple deadlines.

· Respect the sensitive nature of the role due to access to confidential data.

Qualifications

At Solis Mammography, we save lives. We shape the future of women's health. We are empowered, appreciated, and part of something bigger. Together, we deliver compassionate, exceptional care. Every patient. Every time.

Our patient-focused culture is at the heart of every interaction. We deliver the care, compassion and high-touch experience that have made us a valued healthcare partner to the generations of women that we serve. As the nation's leader in breast health services, our commitment to providing excellence in patient care is realized at every level of our organization.