Compliance Specialist

Position Summary:

Under the general direction of the Director of Compliance, the Compliance Specialist will be responsible for ensuring that workforce members are current with compliance training, managing the patient feedback incident reporting system, and performing compliance administrative tasks.

Primary Responsibilities:

• Maintain knowledge of the federal, state, local and regulatory requirements relevant to your position to ensure compliance.
• Participate in meetings, serve on committees, and may be called upon to lead ad hoc group discussions.
• Record the minutes of risk and compliance committee meetings.
• Complete assigned projects.
• Assist the Director of Compliance with performing audits and tracking compliance audits conducted by other departments and serves as primary scheduling liaison for requested compliance audits – both internal and external. 
• Assist the Director of Compliance with annual FTCA deeming application submission.
• Conduct educational presentations for new hires and deliver compliance presentations as needed.
• Must use sound judgment to determine when and to whom to escalate issues to ensure resolution.
• Must adhere to HIPAA and protect the confidentiality and sensitivity of patient information.
• Must meet service level expectations and identified key performance indicators.
• Required to follow standard operating policies and procedures, while delivering expedient, professional responses to patients’ inquiries and concerns.
• Must attend staff meetings and trainings.
• Other duties as assigned.

Patient Feedback Incident Reporting System (RL Datix)

• In collaboration with the Director of Compliance, the Compliance Specialist will manage the patient feedback entered into our incident reporting system.
• Ensure that all feedback complaints are properly entered into RL Datix. Assign supervisors to review patient complaints.  Ensure the review is completed in a timely manner in accordance with policy
• Assist the Director of Compliance with performing data analytics, compiling, and generating reports for presentation at committee meetings.

            Mandatory Compliance Training

• Contribute to the development, implementation and maintenance of compliance materials, training modules and work plans.
• Conduct and monitor attendance at compliance education and training sessions, online or live, as required.
• Monitor updates to federal and state laws and regulations applicable to our mandatory compliance training.
• Assist workforce members with all aspects of compliance training: signing on, training reminders.
• Ensure that all workforce members have taken their mandatory compliance training by assigning in HC Pros and sending reminders to employees and managers.

Policy and Procedures

• Maintain a spreadsheet of all policies and procedures. Track the due dates of policy and procedure reviews.
• Work closely with Communications to ensure the most current version of policies and procedures are posted in the Policy Manual (on-line and hard copy).

Compliance Hotline

• Check compliance hotline for messages each morning.
• Prepare a Compliance Hotline Log intake form for each message received.
• Review the intake form with Compliance Director to determine appropriate next step. (i.e., complaint, safety event/injury, request for assistance, etc.)

OIG Exclusion and State Sanction Reviews

• Coordinate with Human Resources and Finance Departments to ensure the review database is updated accurately.

Qualifications and Skills:

• Bachelors degree is preferred. Equivalent work experience will be considered.
• A minimum of 2 years’ experience in a medical/clinical office environment or Health or Dental insurance industry and EPIC experience are preferred.
• Haitian Creole or Spanish Language preferred.

• Excellent customer service and interpersonal skills.  
• Ability to interact with diverse patient population.
• Solid computer literacy: ability to multitask, organize and prioritize one’s own work.
• Solid understanding of medical insurance terminology.
• Solid knowledge of insurance plans, concepts and terms.
• Expected to stay abreast of scheduling rules, health care insurance changes and referral requirements.
• Ability to quickly learn new systems and tasks, work as a team member and independently.
• Ability to work in a fast-paced environment.
• Ability to listen well and devote full attention to patients and medical professionals alike.
• Ability to be compassionate, caring, and to remain calm, even under stressful situations.
• Maintain a high level of confidentiality.
• Comfortable public speaking in front of small and large groups.

Physical Requirements

• Must be able to stand or sit for prolonged periods (50% of the time)
• Must be able to lift up to 25 pounds and load onto shelves
• Visual acuity sufficient for frequent reading and computer use