JOB SUMMARY:
Is responsible for determining all functions impacted by external governing organizations and ensures compliance. Serves as Compliance Officer and Privacy Officer and manages legal risk as described.
MAJOR DUTIES AND RESPONSIBILITIES:
Analytical and Critical Thinking
* Identifies potential areas of compliance vulnerability
* Investigates claims of non-compliance submitted through Employee Hotline or other means
* Manages all required breach determination and notification processes under HIPAA
* Manages malpractice risk through involvement in the credentialing and privileging process
* Identifies legal high risk areas through risk assessments and other means
* Reviews subpoenas and coordinates with local law enforcement as needed
Compliance, Policy, Risk Management, and Procedure
* Develops initial and ongoing compliance training for the workforce
* Serves as Compliance Officer
* Serves as Privacy Officer
* Serves as Risk Manager
* Oversees compliance with new and existing federal, state, and local regulations (including compliance requirements for HRSA's 330 grant, the 340B discount pharmacy program, and the FTCA)
* Drafts new policies, ensuring compliance with laws and regulations
* Reviews existing policies for regulatory and statutory compliance
* Develops and maintains the organization Compliance Plan, compliance policies and procedures, and related forms
* Develops and implements privacy and confidentiality policies and procedures and related forms
* Develops and initial and ongoing privacy training to the workforce
Checking, Examining, and Recording
* Collects, organizes, and reports on audit reports
* Audits credentialing files intermittently for compliance and in anticipation of audits
* Compiles monthly and quarterly risk management reports for committee use and board review
Planning and Organizing
* Coordinates site visits and compliance reviews by State and Federal regulators
Communication
* Provides monthly reports to the Quality Excellence Committee
* Cooperates with regulators and entities in compliance reviews or investigations
* Collaborates with the IT Security Officer to ensure alignment between security and privacy compliance programs including policies, practices, and investigations
* Collaborates with the IT Security Officer to establish an ongoing process to track, investigate and report inappropriate access and disclosure of protected health information
* Cooperates with the U.S. Department of Health and Human Service's Office for Civil Rights, State regulators and/or other legal entities in any privacy compliance reviews or investigations
* Works with the relevant departments in overseeing patient rights to inspect, amend, and restrict access to protected health information when appropriate
* Investigates staff and liaisons with HR pursuant to disciplinary measures
* Interfaces with all departments to coordinate and resolve compliance issues
* Consults with Finance and the insurance broker regarding wraparound coverage
* Answers legal and risk management inquiries from providers
* Responds to licensing boards, Joint Commission, or other entities conducting investigations
* Coordinates with assigned counsel in the event of any malpractice claims
* Provides liaison to outside counsel on other legal matters that cannot be handled in house
SKILLS AND ABILITIES:
* Ability to synthesize and evaluate issues and recommend solutions as appropriate
* Ability to analyze and solve problems
* Ability to multi-task, prioritize, and work under deadlines
* Ability to work collaboratively with national, state, or local auditors
* Ability to communicate and negotiate with people at all levels
* Ability to work effectively with a variety of people in a team environment
* Ability to adapt to changes/challenges in organizational strategy, priorities, and directions, and the ability to overcome resistance to change
* Ability to communicate clearly and effectively
EDUCATION AND/OR EXPERIENCE:
* Required: BS/BA in Nursing with current RN degree or Juris Doctor and barred in Maryland
* Required: Minimum of 2 years relevant experience required; 5-7 years preferred
* Preferred: Experience with FQHCs or Look-Alikes