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Open nowPosted 15 days ago

Healthcare Compliance Reviewer (Medicaid Provider Oversight) - North Carolina

ssollc32 open roles

Where
Winston-Salem, NC, USA
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Your applicationOpen nowHealthcare Compliance Reviewer (Medicaid Provider Oversight) - North Carolinassollc · Winston-Salem, NC, USA

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  5. 33.7%30 days
This job: posted 15 days ago

The posting

Healthcare Compliance Reviewer (Medicaid Provider Oversight) North Carolina - Field-Based - 9 Openings Locations: Please see the map for your location. 1 - Asheville Region 2 - Charlotte Region 3 - North Central (Raleigh/Charlotte Region) 3 - East Coast Region  

  Employment Type: Full-Time Position Overview Staffing Solutions Organization (SSO) is seeking highly motivated Healthcare Compliance Reviewers (Medicaid Provider Oversight) to conduct field-based reviews of North Carolina Medicaid providers. This role is responsible for helping ensure providers are delivering legitimate services, operating in compliance with applicable North Carolina Medicaid requirements, and conducting business at approved service locations. Using a comprehensive review checklist approved by the North Carolina Department of Medicaid, the Onsite Reviewer will independently conduct site visits, evaluate provider operations and documentation, and prepare detailed reports regarding provider compliance and enrollment status. This position requires extensive daily travel throughout North Carolina, with occasional overnight travel based on assigned territories and schedules.

Key Responsibilities

Travel daily to Medicaid provider locations throughout North Carolina. Conduct onsite reviews to verify provider operations, service delivery, and compliance requirements. Complete North Carolina Medicaid-approved site review checklists and conduct provider interviews according to established protocols. Observe, assess, and document provider practices, policies, and procedures. Prepare detailed, accurate, and professional reports documenting site visit findings. Submit all documentation within established quality assurance and compliance deadlines. Analyze information gathered during reviews and provide recommendations regarding provider enrollment or continued participation in Medicaid programs. Maintain strict confidentiality regarding provider information and site review findings. Meet established productivity, quality, and customer service standards. Independently manage travel schedules, workloads, timelines, and deadlines. Address provider concerns professionally and identify opportunities for process improvement. Evaluate provider documentation and operational practices to ensure compliance with North Carolina Medicaid requirements. Utilize tablets, Microsoft Office applications, and reporting systems to complete reviews and documentation. Represent SSO professionally during all provider interactions.

Minimum Qualifications

Bachelor's degree preferred but not required. Valid driver's license with an acceptable driving record. Current automobile insurance. Ability and willingness to travel extensively throughout North Carolina. Experience using iPads, tablets, or mobile technology. Proficiency with Microsoft Office applications. Strong written communication, documentation, and dictation skills. Excellent organizational, analytical, and time-management skills. Ability to work independently with minimal supervision. Professional demeanor with strong interpersonal, listening, and communication skills.

Preferred Experience Minimum of two (2) years of experience in one or more of the following areas:

Public Health Critical Care Home Health Long-Term Care (LTC) Developmental Disabilities Services Children's Services Elder Care Services Behavioral Health or Mental Health Services Community Social Services

Additional experience in one or more of the following areas is preferred:

Medicaid programs Provider monitoring or auditing Third-party billing Provider training and education Healthcare compliance Quality assurance Healthcare administration

What We're Looking For The ideal candidate is:

Honest, dependable, and self-motivated. Comfortable working independently in a field-based environment. Detail-oriented with strong investigative and observational skills. Skilled at analyzing information and making objective recommendations. Able to manage competing priorities and deadlines. Customer-focused with excellent problem-solving abilities. Committed to maintaining confidentiality and professional standards.

Benefits Through Staffing Solutions Organization (SSO) SSO offers a competitive benefits package that may include:

Medical Insurance Dental Insurance Vision Insurance 401(k) with Employer Match Paid Time Off (PTO) Paid Holidays Flexible Spending Accounts (FSA) Employee Assistance Program (EAP) Additional Employee Perks and Discount Programs

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