Compliance & Policy Analyst
The Compliance & Policy Analyst: (1) manages the TMC HealthCare Policy Management System; (2) maintains compliance databases, (3) generates and analyzes compliance and privacy reports, (4) participates in conducting compliance investigations, (5) monitors and tracks operational adherence to compliance policies and applicable regulations, (6) provides administrative support to the department, and (7) participates in ongoing compliance activities.
Tracks operational adherence to established compliance expectations and provides current state metric reports of such activity no less than quarterly.
Maintains master user list for Conflict of Interests Disclosure Statements. Prepares disclosure statements for TMC HealthCare management, employed physicians, medical directors, Board members, and other individuals as required by policy upon hire and annually. Prepares resolution statements as directed by the Office of General Counsel.
Coordinates and participates in completion of HIPAA Walk-Through exercises.
Coordinate meetings of the TMC HealthCare Compliance Committee by scheduling meetings, gathering and analyzing metrics, preparing a metric summary, documenting meeting minutes, and preparing all materials for Manager and Director review.
Provides oversight of document destruction status and plans, and provides guidance to operational leaders on management of document retention and destruction efforts.
Conducts proactive privacy monitoring by generating reports and identifying any suspicious activity.
Maintains incident logs of compliance investigations and outcomes, and prepares notification and response letters when necessary.
Submits annual HIPAA incident reports to the Office for Civil Rights.
Reviews requests and internal responses related to medical record amendment or restrictions.
Tracks Recovery Audit Contractor (RAC) documentation requests, TMC’s responses, review outcomes, and appeal activity. Works with designated appeal vendor to facilitate review of denials and potential appeal of denials payment.
Reviews, analyzes, and responds to reports received in the non-monetary compensation tracking database.
Liaises with and supports policy owners and executive sponsors in proper policy template utilization, document cataloging, and timely policy review and approval.
Works with Policy Management System vendor and internal development team to maintain and improve the organization, structure, and end-user functionality of the system.
Participate in workgroups, committees, or subcommittees with oversight of the TMC HealthCare Policy Management System.
Adheres to and supports team members in exhibiting TMC HealthCare values of integrity, community, compassion, and dedication.
Adheres to TMC HealthCare organizational and department-specific safety and confidentiality policies and standards.
Performs other related duties as assigned.
EDUCATION: Associate's degree or equivalent from two-year college or technical school. Bachelor’s degree preferred.
EXPERIENCE: Three (3) years of relevant experience.
LICENSURE OR CERTIFICATION: None required. Certification in Healthcare Compliance (CHC) preferred.