Clinical Compliance Specialist

Clinical Compliance Specialist
in Boston, Massachusetts 02109 - US

Job Description

Clinical Compliance Specialist


There is an immediate opening for a clinical compliance specialist to join our reputable organization. We are one of the most well-known healthcare providers in the Boston area (Medford) and are looking to add to our staff immediately. With the rapid growth in our clinical compliance department, the ideal candidate with start right away reporting directly to the supervisor of member/provider appeals and grievances and joining an established team of clinical professionals. This position offers unlimited potential for growth and has lots of visibility working with high ranking company officials. This opportunity is a perfect fit for candidates with a background in healthcare compliance who are looking to take the next step in their career.


Responsibilities Include:
-Processing member appeals and provider grievances by research and categorizing them accordingly
-Acting as a liaison for the different levels of clinical professionals in the department
-Corresponding with necessary members when required
-Organizing, planning, and implementing functions for all member grievances and provider appeals
-Maintaining timelines and turnaround times to meet any regulations established by regulating bodies for the state and federal laws.
-Managing day to day occurrences while prioritizing multiple projects using appropriate judgment
-Analyzing solutions to determine which grievances/appeals can be resolved at your level and which issues require escalations


Requirements:
-2-3 years of previous experience in healthcare compliance
-4 year degree or equivalent experience in healthcare or conflict resolution
-A background with a heavy emphasis on compliance or customer service is preferred
-Effective interpersonal and communication skills are needed
-Basic knowledge of medical terminology is a plus

 

If you're interested in joining our team, please submit a resume


For questions, please call 617-250-1000. There are no costs for candidates utilizing our services as our clients pay for all related hiring fees. All PSG job postings are either actual positions we had available at the time of posting and/or are representative of positions we typically fill or expect to fill. If you see a job that interests you, respond to the ad or give us a call so that we can help you find a job you'll love. As one of the area's largest staffing firms, we help 2,500 people find jobs a year so chances are good that we can help you too.

Professional Staffing Group is an equal opportunity employer and considers qualified applicants for employment regardless of race, gender, gender identity, gender expression, age, color, religion, disability, veteran's status, sexual orientation, or any other protected factor.

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