Job Summary:

As a national provider of pharmaceutical and health care services with complementary businesses in both the retail and commercial segments of the industry, the Compliance Coordinator is responsible for working with company management to coordinate responses to inquiries and audits from Third Party Payors. The Compliance Coordinator must maintain confidentiality and is expected to exercise discretion, initiative, and professional judgment. Work is performed under general supervision of the Compliance Manager, and the Director of Internal Audit.  

This is not a remote opening and can only be in office.

Job Duties:

• Perform daily tasks relating to Third-Party Audit requests and Fraud Waste & Abuse investigations
• Respond to virtual desk audits and investigations from insurance payors, accrediting bodies, and government agencies
• Attend on-site audits and investigations to assist external auditors
• Properly document all requests and actions taken per Compliance Department policy
• Index all incoming requests and communicate to appropriate division/department and stakeholders
• Source appropriate documentation and evidence to respond to requests
• Coordinate with division leadership and management staff to research any missing documentation
• Ensure management approval and verification of submissions to mitigate loss
• Review audit findings for potential appeals opportunities
• Coordinate and submit appeals
• Perform other duties as assigned

Education:

• Minimum: High School Diploma or GED

 Experience:

• Required: 1-2 years’ experience in a similar role or Pharmacy experience

Special Conditions of Employment:

• Any and all additional eligibility requirements based on the specific position
• Drug Test
• Initial and continuous exclusion and sanction/disciplinary monitoring

Compensation

$20.63 - $25.57 per hour

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.  

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state, and federal regulations as it pertains to minimum wage requirements.