Implementation and Compliance Specialist in San Diego, California at Mitchell International

Mitchell International
Implementation and Compliance Specialist

US--Remote

Job ID: 26-19310
Type: Regular Full-Time
# of Openings: 1
Category: Insurance & Administration
Mitchell International, Inc.

Overview

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

Responsibilities

We are seeking a detail-oriented and analytical professional to join our team as an Implementation and Compliance Specialist. This role will lead new implementation projects, manage reporting and data analysis, and provide junior-level compliance support. The ideal candidate will have strong project management skills, excellent communication abilities, and a keen eye for data analysis.

Key Responsibilities:

1. Implementation Project Management:

• Lead new implementation projects from inception to completion

• Attend all project-related meetings and coordinate with stakeholders

• Conduct rule reviews for system setup

• Communicate with professional services and operations teams on special requests or changes

• Coordinate testing procedures and obtain signoff from relevant parties

• Provide support during the warranty period

1. Reporting and Data Analysis:

• Manage and execute daily, weekly, monthly, yearly, and ad hoc reporting requests

• Analyze data to identify trends, areas of concern, and potential opportunities

• Provide recommendations based on data analysis to improve processes and outcomes

• Perform data analysis to identify root causes of client account issues

• Utilize analytical insights to recommend solutions and process improvements

• Support bill review and clinical review processes as needed

• Present findings and recommendations in a professional, consultative manner

1. Compliance Support:

• Research legislation and fee schedules to determine support for company positions

• Monitor changes to fee schedules and update the team on potential impacts to products

• Facilitate answers to escalated inquiries regarding compliance support

• Assist in ensuring company products and processes adhere to relevant regulations and standards

1. Clinical Edits Research Team Lead

• Lead & manage clinical edits research team of coders and nurses; oversee CPT, AAOS, and Relatedness code master reviews

• Coordinate projects across divisions, manage timelines, and ensure timely completion and submission of master files to automated systems

• Create & train comprehensive working documents and provide staff training on new clinical edits requirements and processes

• Research & escalate complex coding questions and clinical edits inquiries; provide expert guidance and resolution

Qualifications

• Bachelor's degree in Business Administration, Information Systems, or related field

• 3-5 years of experience in workers compensation medical bill review.

• Strong analytical and problem-solving skills

• CPC a requirement.

• Excellent communication and interpersonal abilities

• Proficiency in data analysis tools and reporting software

• Knowledge of regulatory compliance in relevant industry (preferred)

• Ability to manage multiple projects and priorities simultaneously

• Detail-oriented with a strong focus on accuracy

• Demonstrated ability to handle sensitive information professionally

• Strong analytical and problem-solving abilities

• Experience with data analysis and reporting

• Experience managing escalated client situations

Benefits

We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $53,000 - $70,000 annually, and will be based on a number of additional factors including skills, experience, and education.

The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.

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