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.
• 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 inquires and concerns.
• Must attend staff meetings and trainings.
• Other duties and/or other locations 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.
• Perform data analytics compile and generate reports for presentation at committee meetings.
• Acknowledge patient complaints in writing and in a timely manner but no later than seven days after receiving the complaint and document the acknowledgment in RL Datix.
• Assign supervisors to review patient complaints. Ensure the review is completed in a timely manner in accordance with policy.
• Assist all workforce members with entering feedback complaint into RL Datix; and assist assigned supervisors with the investigation of feedback complaints.
• Ensure that all feedback complaints are properly documented in RL Datix from the initial complaint to its conclusion.

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.
• Maintain an accurate employee list in our training program Healthcare Compliance Pros (HCP).
• Assist workforce members with all aspects of compliance training: signing on resetting passwords 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.
• Notify department leaders if a workforce member has not completed their training within in two weeks of notice.

Policy and Procedures

• Track the due dates of policy and procedure reviews.
• 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

• Perform monthly OIG exclusion and state sanction reviews on employees and vendors by utilizing Verify Comply .
• Coordinate with Human Resources and Finance Departments to ensure the review database is updated accurately.

Qualifications and Skills:

• Bachelors degree required.
• A minimum of 2 years experience in a medical/clinical office environment or Health or Dental insurance industry required.
• Previous customer service background required.
• Haitian Creole or Spanish preferred.

• Excellent customer service and interpersonal skills.
• Ability to interact with diverse patient population.
• Solid computer literacy: ability to multitask organize and prioritize ones 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 sit or stand for prolonged periods of time.
• Must be able to lift 10 pounds and load onto shelves.

CODMAN SQUARE HEALTH CENTER MISSION VISION AND VALUES

Mission: To serve as a resource for improving the physical mental and social well-being of the community.

Vision: Codman Square Health Center is our communitys first choice for comprehensive holistic and integrated services and empowers individuals to lead healthy lives and build thriving communities.

Values: Patients- Our patients are the center of our care team.

Community- The well-being of the individual is deeply connected to the health of the community.

Advocacy- We advocate for responsive policies and resources to address health disparities and promote health equity.

Staff- We are a diverse empowered compassionate and prepared workforce.

Innovation- We promote a culture of innovation that has measurable and sustainable impact.

Partnership- We build and sustain diverse partnerships.

Codman Square Health Center is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race sex color religion national origin sexual orientation protected veteran status or on the basis of disability.