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  • Bannockburn, IL 60015

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Compliance Specialist

Option Care • Bannockburn, IL

Posted 22 days ago

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Job Description

Your Home for an Exceptional Career.

With the nation’s largest home infusion provider, there is no limit to the growth of your career.

For nearly 40 years, Option Care has been shaping the home infusion services industry. From industry pioneers to trusted partners, Option Care has emerged as the leading home infusion services provider. Our company has grown over 5,000 strong—a workforce that spans the nation and is united by a common passion for making exceptional healthcare synonymous with home.

Job Description Summary:

Reporting to the Manager, Compliance Audit, the Coordinator is responsible for entering payer audit information into central tracking database, compiling responsive, accurate records and submitting responses consistent with payer directions by audit deadlines. Partners with clinical, operations and reimbursement teams as necessary to gather necessary information. Receives findings from payer audits and updates entries in central tracking database; reviews findings with Manager, Compliance Audit Coordination and conducts follow up with Operations and Reimbursement teams as needed to support decisions to appeal. Gathers information necessary for appeal and review with Compliance leadership; prepares appeal submissions. Supports implementation of corrective action, including communicating and following up on claim corrections, re-training and obtaining status updates for other departments. Prepares reports on audit activity for Compliance leadership, Operations and Reimbursement teams as directed.

Job Description:

Job Responsibilities (listed in order of importance and/or time spent)

Receives audit requests from payers or their contracted auditors, for clinical and operational documentation in support of services provided by Option Care. Enters payer audit  requests, findings, appeal information and corrective action and any other updates in the Payer Audit database; compiles responsive records from Option Care systems to ensure timely and responsive submissions to payer audits;  contacts and conducts follow up with Option Care operations, clinical, reimbursement and other teams as needed. 

Coordinates with external payer auditors and Option Care locations/departments under review to foster understanding of audit requests, payer reimbursement requirementsto submit required documentation, correspondence, responses, appeal information or other necessary follow up as needed related to the audit process within deadlines.

Gathers patient records and/or operational documentation from electronic and paper record systems to compile accurate and fully responsive audit submission in support of claims.

Prepares correspondence, records and other documentation for submission to audits, reviewing the same for accuracy, legibility and HIPAA requirements are met, specifically ensuring patient information is securely sent out and that no more information than is responsive and required is submitted.

Receives and reviews audit findings; updates entries in central tracking database; prepares communications, reports and other updates on findings to Manager, Compliance Audit Coordination as well as impacted departments.Supports development of appeal submissions and/or internal corrective actions to address findings.

Escalates and reports serious compliance, billing, quality or other business risks timely to the Manager, Compliance Audit Coordination and/or the Chief Compliance Officer and other functional leadership by demonstrating the ability to exercise good independent judgment in assessing the significance and relevance of identified issues.

Prepares reports as directed on audit activity; Conducts follow up on corrective action to ensure timely completion.

Develops and manages strong working relationships with other team members and leaders within Option Care departments and locations.

Other duties as assigned to support Compliance Department and/or Option Care business.

Supervisory Responsibilities

Does this position have supervisory responsibilities?

(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

No        X


Basic Education and/or Experience Requirements

Bachelor’s degree in business or a healthcare related field preferred

1-3 years experience in compiling patient records, payer billing and/or compliance auditing in healthcare environment, preferably in home infusion/home health setting.

Basic Qualifications

Demonstrated effective communication, organizational, and writing skills with strong attention to detail Strong computer skills, including proficiency in Microsoft Office Suite applications

Working knowledge and understanding of federal and state healthcare regulations

Skilled in problem solving and critical analysis

Skilled in developing and delivering presentations

Travel Requirements:  (if required)

Up to 25%

Preferred Qualifications & Interests (PQIs)

Familiar with pharmacy billing

Experience with CPR+ and/or iEmphysis

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.

Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.

Job ID: R6470
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