Compliance Specialist

The Position Under direction, the Compliance Specialist - Registered Nurse provides medical expertise for the Division of Industrial Relations, Workers' Compensation Section. Incumbents monitor compliance and detect violations of State laws and/or regulations by medical providers, insurance carriers, Third Party Administrators (TPAs), medical billing vendors, employers, and in Permanent Partial Disability (PPD) reports; supervise lower-level Compliance/Audit Investigators; and oversee the Medical Unit in their assigned regions. This recruitment is for a Compliance Specialist, Registered Nurse (RN) within the Department of Business and Industry's Industrial Relations Division. This position provides medical expertise for the Workers' Compensation Section; monitors compliance, detecting violations of State law by medical providers, insurers, third-party administrators, medical billing vendors, and employers; maintains Treating and Rating Panels of Physicians and Chiropractors as well as posting of insurers' provider lists as directed by the Compliance Coordinator-RN; supervises subordinate Medical Unit staff in the office; verifies medical providers and that claim file records are complete and appropriately documented; ensures authorized services correlate with services provided/billed through the review of medical records; conducts interviews with stakeholders; documents findings and deficiencies; makes determinations regrading program violations, including recommendations for administrative actions such as fines; gathers data and assists with revising the Medical Fee Schedule; provides advice and assistance in the preparation of medical documentation and testimony for hearings/appeals; ensures compliance with standards of health care; trains internal and external stakeholders; investigates and recommends a warning, suspension, or removal of a provider from provider panels; conducts audits; reviews and identifies errors on Permanent Partial Disability (PPD) reports and facilitates PPD Review Panel meetings; resolves medical billing disputes, writing formal determinations as needed; and performs related duties as assigned. The State of Nevada is committed to Equal Employment Opportunity/Affirmative Action in recruitment of its employees and does not discriminate on the basis of race, color, national origin, religion or belief, age, disability, sex, sexual orientation, gender identity or expression, pregnancy, domestic partnership, genetic information (GINA), or compensation and/or wages. THIS RECRUITMENT MAY CLOSE WITHOUT FURTHER NOTICE DEPENDING ON THE NUMBER OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE To see full Class Specifications visit: