Director of Risk & Compliance

The Compliance Specialists will help ensure that our operations comply with relevant laws, regulations, and policies. You will be responsible for monitoring and documenting compliance activities and advising leadership/management on compliance matters.
ESSENTIAL DUTIES AND RESPONSIBILITIES (Other duties may be assigned)

• Maintain effectiveness of the Compliance Program
• Maintain effective lines of communication that allow employees to report compliance concerns without retaliation. Assists with investigations and responses to violations and corrective actions for reports of alleged noncompliance.
• Detect offenses in a timely manner, responds appropriately to them, and implements any necessary corrective action.
• Collaborate with management and leadership staff to identify concerns and potential solutions.
• Ensure conformance with Federal health care programs such as HIPAA, Anti-kickback Statute, Stark Law, False Claims Act, Medicare billing, etc.
• Attend compliance meetings and drafts committee agendas and materials.
• Serve as corporate resource for healthcare compliance matters, including Medicare reimbursement information, as well as HIPAA and OSHA.
• Serve as liaison between practice and third party coding/billing vendor.
• Coordinate provider and/or staff education with vendors when appropriate.
• Evaluate, develop, and modify policies and procedures to conform to relevant state, federal, regulatory, and/or industry standards and requirements.
• Develop and provide education and training for providers and employees on the Compliance Program
• Assist HR in conducting new hire training and ensuring all employees complete annual compliance attestations.
• Coordinate and oversee compliance audit processes and monitoring activities, including coding/billing, HIPAA, OSHA, etc.
• Serve as HIPAA/Privacy Officer to manage and coordinate ongoing activities related to the development, implementation, maintenance of, and adherence to the organization’s policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the healthcare organization’s information privacy practices.
• Work with HIPAA Committee and management to ensure the organization has and maintains appropriate privacy and confidentiality consent, authorization forms, and information notices and materials reflecting current organization and legal practices and requirements.
• Establish with management, the HIPAA/Privacy Committee, and operations a mechanism to track access to protected health information, within the purview of the organization and as required by law.
• Establish and administer a process for receiving, documenting, tracking, investigating, and taking action on all complaints concerning the organization’s privacy policies and procedures in coordination and collaboration with other similar functions and, when necessary, legal counsel.
• May perform periodic information privacy risk assessments and conduct related ongoing compliance monitoring activities in coordination with other compliance and operational assessment functions.

NON-ESSENTIAL DUTIES AND RESPONSIBILITIES

• Additional duties as assigned

EDUCATION AND EXPERIENCE

• Bachelor’s degree in business administration, a science or healthcare discipline, or related field.
• At least two (2) years of related compliance experience with a background in healthcare regulatory issues, including general familiarly with medical billing.
• Experience and working knowledge of Corporate Compliance, Audit, Legal, Privacy, or Information Security. Experience with case investigations management and compliance hotline management preferred.

SKILLS/ABILITIES

• Current knowledge of healthcare regulatory and compliance issues
• Proven organizational skills and administrative ability
• Competency in EMR
• Competency in Microsoft Office to include Excel, Word, PowerPoint, etc.
• Strong oral and written communication skills
• Ability to interpret and apply federal and state statutes, regulations, accrediting body standards and requirements
• Demonstrated ability to plan and carry out short and long-term projects
• Must be self-motivated and able to evaluate the scope of each day’s work and use time management and organizational skills to accomplish assignments

PHYSICAL DEMANDS While performing the duties of this job, employee is regularly required to sit, stand, walk, reach with hands and arms, and to talk and hear. Employee may be occasionally required to climb or balance, stoop, kneel, or crouch. Employee must occasionally lift, push and/or move up to 30 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.WORK ENVIRONMENT While performing the duties of this job, employee may be exposed to risk of infectious diseases when interacting with patients and/or family members. The employee may be occasionally exposed to wet and/or humid conditions, moving mechanical parts, fumes or airborne particles, toxic or caustic chemicals and vibration. The noise level in the work environment is typical of an office setting.The above describes the general content of and requirements for the performance of this position. It is not intended to be an all-inclusive statement of the duties, responsibilities and requirements of the position.PRIVACY & SECURITY AWARENESSWhile performing the duties of this job, it is imperative that the employee remain aware of Resurgens policies, Information Security policies, standards, guidelines and procedures for minimizing threats and ensuring protection of PHI. The success of HIPAA policies and procedures is dependent upon the awareness and buy-in of everyone involved in daily healthcare operations, including reporting incidents to their supervisor or directly to the HIPPA leadership.