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CORPORATE COMPLIANCE REVIEWER

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Job Summary

Company
CenterPoint Human Services
Location
Winston-Salem, NC 27106
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Education Level
Master's Degree
Career Level
Experienced (Non-Manager)
Salary
48,465.00 - 54,523.00 $ /year

CORPORATE COMPLIANCE REVIEWER

About the Job

 

TITLE:     CORPORATECOMPLIANCEREVIEWERFraud & Abuse(Licensed)

HOURS:      8:00am5:00pm  M-F

HIRINGSALARY:  $48,465-$54,523(DOE)Full-time,Exempt

 

DUTIES PERFORMED:
T
heCorporateComplianceReviewerLicensedFraud&Abusestaffareresponsibleforthefollowing(notan inclusivelist,asadditionaldutiesmaybeassigned):

    Assists the Corporate Compliance Officer with development, revision and maintenance of policies  and procedures for the general operation of the Compliance Program and its related activities to  prevent illegal, unethical, or improper conduct.

    Assists  the   Corporate  Compliance  Officer   with   developing,  coordinating,  and  participating   in   a multifacetededucationalandtrainingprogramthatfocusesonthecomplianceprogramsothat  MCOemployees,NetworkProviders,andenrolleesareknowledgeableof,andcomplywith,pertinentfederalandstatestandards.

    Completion ofclinicalreviewsoccurringasaresultofsanctionsappliedtoNetwork providersforreasonsofsuspectedfraud,wasteandabuse(i.e.pre-pay reviews) orasapart ofaninvestigationintoallegationsor  suspected  fraud,  waste  and  abuse  (i.e.  clinical  review  of  enrollee  records   including   servicedocumentation,clinicalcomprehensiveassessmentsandtreatmentauthorizationrequests).

    Maintains a current working knowledge of Federal and State regulations and policies as they affect the

MCO and its Network Providers.

    Completes  compliance  research  on  specific  topics,  such  as  Privacy  regulations,  Conflict  of  Interest

Standards, and provides examples of industry risk analysis as requested.

    Conductsresearchonindustrycomplianceeducationandreference documents. Summarizesinformationintoa formatformeetingandpresentationpurposes.

    Performs internal and external compliance reviews and monitors activities, including periodic reviews

(administrative and clinical) of departments and Network Providers.

    Supports  investigations  and  matters  related  to  compliance,  including  the  flexibility  to  design   andcoordinateinternalinvestigations(e.g.respondingtoreportsofproblems,hot-linecalls,or  suspectedviolations)andanyresultingcorrectiveactionswithemployeesandNetworkProviders.

    MonitorstheperformanceoftheComplianceProgramandrelatesactivitiesonacontinuing basis,takingappropriatestepstoimproveitseffectiveness.

    Performs related tasks as required.

 

 

MINUMUM REQUIREMENTS:
Mastersdegree required with demonstratedknowledgeof operational,financial,quality assurance,and human resource procedures andregulations and three to five(3-5)yearsexperience in a health care organization. Corporate Compliance Experience ina customer-services focused environment.  P
ossession of Valid North Carolina professional clinical licensure in behavioral health field (LCSW,LPC,LPA) issued by the State of North Carolina is REQUIRED.  Must possessa valid North Carolina drivers license.

 

APPLICATION PROCESS:
Sub
missionofanoriginalCenterPointHuman Servicesapplicationisrequired.Ifanoffer of employmentisextended,

verificationof educationandclinical licensuremustbe submittedpriortobeginningwork.Anapplicationmaybeobtained fromthewebsiteatwww.cphs.organdsubmittedto:

 

HumanResources

CenterPointHuman Services

4045UniversityParkway

Winston-Salem,NorthCarolina27106

Email:hr@cphs.org       EOE/M/F/D/V

 

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