Legal and Compliance Generalist - Tampa (Not Remote)

JOB PURPOSE

The Legal & Compliance Generalist interacts directly with Patients, Office Managers, District Managers, Government Agencies and Insurance Representatives to reconcile a wide variety of patient concerns. These concerns may stem from the quality of treatment provided at the office, billing issues across one or more dates of service or any other patient complaint. The position will take patient calls as needed and thoroughly audit patient accounts. This position reports to the Senior Legal & Compliance Generalist to achieve timely resolution of concerns.

DUTIES AND RESPONSIBILITIES

•Be the primary responder for the grievance distribution email; logging all emails accordingly and retrieving all necessary documents directly.

•Provides backup support for processing patient medical record requests within 30 days from receipt and maintaining corresponding log.

•Assist Insurance Grievances with resubmitting claims as needed.

•Audit patient records, investigate the allegations raised by the patient, and prepare responses to grievances/complaints as needed. Work in conjunction with Senior Legal & Compliance Generalist for more technical responses where the quality/necessity of treatment is in question.

•Detailed account auditing for billing purposes, using Explanation of Benefits (EOBs), sales receipts, or other credible sources of information pertaining to the issue at hand for any given patient account.

•Create and Monitor refunds and adjustments request for each complaint to ensure a timely process window.

•Collaborate with the Legal Department to write off/adjust balances for patients who have filed bankruptcy.

•Research and respond to Better Business Bureau and FDACS Complaints.

•Research and defend against all credit card disputes.

•Audit patient records to confirm if their account balance is accurate for purposes of   taking patient to small claims court.

•Be a resource for the offices in regard to patient complaints and balances.

•Specific projects and tasks as assigned by the General Counsel & Chief Compliance Officer

•All other duties and responsibilities as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATIONS

•Two years related dental office experience and/or training.

•Effective problem solving and analytical skills: ability to take an analytical approach to complex problems, synthesizing diverse information.

•General understanding of insurance claims and submissions.

•Skilled writer.

•Maintain strict confidentiality with sensitive patient information.

•A good comprehension of Microsoft Windows computing knowledge, including track changes.

•Able to work independently, while reporting on progress to direct supervisor(s).

•Ability to handle sensitive information and maintain strict confidentiality.

•Strong organizational skills and attention to detail.

•Proficient in oral communications, always demonstrating professionalism and taking accountability for actions.

•Collaboration amongst team members.

•To perform this job successfully, an individual must possess proficient knowledge of: internet software, spreadsheet manipulation via Microsoft Excel, word processing software via Microsoft Word, Outlook, and PowerPoint.

•Bilingual in Spanish and English is a plus (not required).

WORKING CONDITIONS

The Legal & Compliance Generalist will work in areas that are highly visible and will be provided with comfortable office space to perform the assigned duties. Workstations are clean (floor cleanliness maintained by janitorial staff – desk workspace maintained by the employee), well lighted, and relatively quiet. Work is primarily sedentary in nature.

LIMITATIONS AND DISCLAIMER

The above job description is meant to describe the general nature and level of work being performed, but is not limited to these duties; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.