Associate Manager-Clinical Scope & Code Compliance (Healthcare)

TL;DR

Associate Manager-Clinical Scope & Code Compliance (Healthcare): Coordinating and supporting clinical quality administration processes, including the management of practitioner scope-of-practice databases and regulatory compliance research. Focus on analyzing legislative language, ensuring accuracy in clinical quality tasks, and serving as a resource for compliance inquiries across the organization.

Location: Must be based in the United States

Salary: $56,700–$72,000

Company

hirify.global is a national health services organization specializing in specialty health care programs and fitness and wellness solutions.

What you will do

• Manage and maintain the practitioner scope-of-practice database to ensure up-to-date clinical information.
• Research and analyze legislative and regulatory language, including state and federal insurance benefits like Medicare and Medicaid.
• Draft memos and present findings to internal committees and workgroups.
• Serve as a subject matter expert for directors and staff regarding compliance and procedural inquiries.
• Support the development and writing of Quality Improvement Activities (QIA) and studies.
• Assist in the review of Medical Necessity Review (MNR) forms as needed.

Requirements

• Must be based in the United States
• Bachelor’s Degree or equivalent experience required.
• 2 years of experience in healthcare administration, managed care operations, or health insurance compliance.
• Demonstrated proficiency in English writing and research.
• General knowledge of CPT, ICD, and HCPC coding.
• Ability to work from home with a stable internet connection (minimum 50 down/10 up Mbps).

Nice to have

• Degree in Health Care Policy or Administration.
• Clinical licensure (DC, MD, PT, OT, ST, LAc, or RN).
• Experience with NCQA and URAC accreditation requirements.
• Paralegal or legal secretary experience.

Culture & Benefits

• Full-time employment with competitive compensation.
• Remote work environment with company-provided technology equipment.
• Equal Opportunity Employer committed to diversity and inclusion.
• Supportive environment with opportunities for cross-functional collaboration.