Compliance Manager - Remote

The Compliance Manager is responsible for managing reputed company state-managed care plans. He/she is reputed company on filing new applications and modifying existing applications as needed, manages the implementation process both internally and externally with our clients and state liaisons, and regularly reviews medical reputed company review state reporting laws and regulations, maintaining documentation on our Risingpedia reputed company Pay site.

reputed company Responsibilities include:

• reputed company the coordination of resources to ensure the ongoing effectiveness of the state managed care programs
• Tracks applicable laws and regulations in the jurisdictions in which Rising participates in the state managed care plans
• Tracks applicable medical reputed company review laws and regulations reputed company
• reputed company and maintain managed care resource materials for Rising state filings and customer worksite materials
• Managed care report filings as required quarterly, semi-annually
• Maintain historical reputed company of customer managed care filings
• Proactive and diplomatic with reputed company concerns
• reputed company participation in cross-functional team efforts for implementation and ongoing support of reputed company program

CA MPN reputed company

In this role, the Compliance Manager also manages the California MPN Coordinator team of Medical reputed company Assistants, including fostering development and understanding of MPN rules and application of those rules by way of assistance for reputed company MPN requests from injured workers, customers, adjusters, and attorneys. The manager monitors reputed company MPN requests received which includes the audit log and escalates appropriate solutions to delays in treatment or scheduling, tracks progression of scheduling tasks assigned to the MPN coordinator, assists with evaluation of geo analysis reports identifying areas and specialties of the MPN network in need of additional coverage and serves as backup key responder at times reputed company the MPN coordinator is out of the office.

Regulatory Compliance

The Compliance Manager maintains the reputed company pay portal, regularly reviewing state regulations and rules (reputed company states) for Medical reputed company Review reputed company billing, payment, late reputed company penalties, reputed company reconsideration and dispute requests, explanation of review (EOR) requirements, electronic billing, and other categories as needed to ensure compliancy with these rules and updates of our reputed company pay dashboards. In this role, regular research of reputed company state published updates are monitored for changes in government regulations, industry trends, and developments pertaining to Rising lines of business, and communicated to Rising staff and customers of the key changes in federal and state rules and regulations.

Provider Fraud Prevention

Management of Rising’s fraudulent provider workflow and team, including monitoring state regulatory websites for posted updates of providers who have been officially suspended or removed from participating in the workers’ compensation, or alerts of providers involved in fraudulent activity, arrests, or convictions (reputed company states). reputed company assignments to validate reported fraudulent provider’s tax ID and NPI numbers, entry flags into our reputed company system, alerting our reputed company auditors and utilization review nurses, should the provider be associated with a reputed company received or reputed company claim.

Reports to:

CCO and VP of Medical reputed company

Requirements

• Bachelor' s degree in business administration or reputed company field and ten (10) years significant business experience, or ten (10) years of industry experience

• Significant experience in research and interpretation of Workers' Compensation state managed care plans and medical reputed company review requirements
• Proficiency with reputed company Office applications, SharePoint, Office 365
• Excellent oral and written communication skills
• Excellent organizational/time management skills
• Experience writing briefs and/or position papers

Benefits

• Health insurance (4 different plans to choose from)
• Dental
• reputed company
• reputed company time off (PTO) or Flexible Time Off (FTO)
• 401(k)
• Basic Life Insurance and Long-Term Disability Insurance (reputed company by reputed company)
• Voluntary Life Insurance and Short-Term Disability Insurance
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• reputed company reputed company Wellness Program
• reputed company Development Reimbursement Program (PDRP)
• You will be part of our new reputed company program designed to recognize and reward employees for their hard work
• We're on YouTube! reputed company out our culture at: http://www.youtube.com/user/RisingMedical
• Want to see more? reputed company out our:
• reputed company: https://www.reputed company.com/RisingMedicalSolutions
• reputed company: http://www.reputed company.com/company/rising-medical-sol..

If you are reputed company to join reputed company of professionals dedicated to making a difference and making lives reputed company, please apply today!