Compliance Coordinator at PROMPTCARE COMPANIES INC

King of Prussia, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

11 May, 26

Salary

0.0

Posted On

10 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Compliance, Documentation, Medicare, CMS Regulations, Medical Necessity, Audit Readiness, Authorization Support, Appeals, Analytical Skills, Communication Skills, Utilization Management, Case Management, Clinical Review, Electronic Medical Records, Payer Requirements, Medical Policies

Industry

Hospitals and Health Care

Description

Description The Compliance Coordinator supports the Intake & Resupply organization by ensuring clinical and administrative documentation meets Medicare, CMS, and payer compliance requirements. This role reviews medical records, payer medical policies, and regulatory guidelines to determine eligibility, coverage, and medical necessity. The Compliance Coordinator plays a key role in audit readiness, authorization support, and appeals by identifying documentation gaps, interpreting payer requirements, and partnering with internal teams to maintain compliant, high-quality patient care. Job Type: Full time Job Location: hybrid 2 days per week in King of Prussia, PA Requirements Monitor and ensure compliance with relevant laws and regulations Ensure all facility-based licensure is maintained Monitor and evaluate the performance of the existing Licensure/Registered Agent Vendor Identify areas of non-compliance and assist in developing corrective action plans Keep the Chief Compliance Officer aware of changes to relevant laws and regulations Assist with providing compliance training to staff Assist with Compliance Department activities Prepare and submit reports to management on compliance activities Perform other duties as assigned by the supervisor Qualifications: Prior experience in Medicare Advantage or managed care organizations Certification in Case Management (CCM), Utilization Review (CPUR), or equivalent Experience with audits, appeals, and regulatory compliance Administrative focus Minimum 2–5 years of experience (acute care, managed care, or Medicare populations preferred) Strong knowledge of Medicare Parts A, B, C, and/or D Experience with utilization management, case management, or clinical review Familiarity with CMS regulations, medical necessity criteria, and evidence-based guidelines (InterQual, MCG, or similar) Strong analytical, documentation, and communication skills Proficiency with electronic medical records and clinical review systems Ability to interpret medical records, particularly chart notes including test results, diagnosis, medical verbiage pertaining to diagnosis. Must be able to interpret and comprehend published payer medical policies Determine Contraindicators within published medical policies for acceptance while maintaining compliance practices Job Responsibilities, included but not limited to: The Compliance Coordinator is responsible for evaluating clinical information to determine member eligibility, coverage, and medical necessity in accordance with Medicare regulations, CMS guidelines, and organizational policies. This role ensures compliance with federal requirements while supporting high-quality, cost-effective patient care. Provide feedback and guidance for a written appeals process to overturn authorization denials. Effectively identify missing or non-complaint documentation required under CMS guidelines and published medical policies for governmental and commercial payers. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and listen. This position is highly active and requires standing, walking, bending, kneeling, stooping, crouching, crawling, twisting, and climbing; Maneuver in small areas and frequently lift and/or move 20 pounds or more. Benefits & Perks Comprehensive Medical, Dental, and Vision Package 401(k) Plan with Company Match Generous PTO: Vacation, Sick Time, Personal Days, and Paid Holidays Life Insurance: Standard coverage with optional enhancements Employee Assistance Program: Free counseling and coaching sessions Emotional Well-being and Work-Life Balance Resources Short & Long-Term Disability: Company-paid with optional supplements Accidental Death and Dismemberment Insurance FSA and HSA: Manage healthcare expenses Commuter Spending Programs Volunteer and Engagement Opportunities Employee Referral Bonuses Exclusive Discounts on entertainment, travel, and various other supplemental and cellphone plans Equal Employment Opportunity The PromptCare Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.

Responsibilities

The Compliance Coordinator evaluates clinical information to determine member eligibility, coverage, and medical necessity in accordance with Medicare regulations and CMS guidelines. This role ensures compliance with federal requirements while supporting high-quality, cost-effective patient care.