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Appeals and Compliance Specialist

Company: Insight Global
Location: Renton
Posted on: June 22, 2022

Job Description:


  • 2+ years of appeals and compliance experience in a healthcare, health plan, DOD, federal or Medicare environment
  • Experience with HIPAA, reporting and data around compliance
  • Health information management, accreditation, revenue cycle, and direct compliance experience Plusses
    • Healthcare Compliance Certification (CHC)
    • Coding Certification Day-to-Day The Appeals and Compliance Specialist position provides support to the company government health plan Compliance & Privacy Program. This position may participate in daily operations of the Program, including but not limited to:
      • Workforce orientation
      • Compliance & privacy education
      • Incident response, investigation & documentation
      • Business Associate Agreement negotiation and execution
      • Policy & procedure development
      • Administration of the Conflicts of Interest disclosure and annual training process
      • Compliance monitoring and program-related project management
      • Ongoing progression and maintenance of Compliance Program efforts
      • Compliance programmatic developments, initiatives, and enhancements
        Interprets and advises on the application of Operations Manual, Tricare Policy Manual, state, and federal laws such as HIPAA (Health Insurance Portability & Accountability Act), Privacy Act, HITECH (Health Information Technology for Economic and Clinical Health), Stark, anti-kickback, fraud, waste, and abuse, and antitrust. Develops and oversees a system for handling matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of breaches) and any resulting corrective actions with all health system departments, providers and sub-providers, agents and, if appropriate, independent contractors; Ensures compliance with privacy practices and consistent application of sanctions for failure to comply with privacy policies for all individuals in the organization's workforce, extended workforce, and for all business associates, in cooperation with Human Resources, administration, and legal counsel as applicable.

Keywords: Insight Global, Renton , Appeals and Compliance Specialist, Other , Renton, Washington

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