Compliance & Policy Analyst

SUMMARY:

The Compliance & Policy Analyst: (1) manages the TMC’s 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.

ESSENTIAL FUNCTIONS:

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’s 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’s Compliance Committee by scheduling meetings, gathering and analyzing metrics, preparing a metric summary, documenting meeting minutes, and preparing all materials for 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.

Participates in development, initiation, and completion of annual Compliance Risk Assessments and Work Plan projects.

Conducts investigations and audits. Prepares reports on investigations and audits with clear and concise findings and recommendations.

Collaborates with TMC’s Compliance Officer to develop and deliver effective compliance training programs to include new employee orientation, targeted education, and ongoing education for Workforce Members.

Participate in workgroups, committees, or subcommittees with oversight of the TMC’s Policy Management System.

Adheres to and supports team members in exhibiting TMC’s values of integrity, community, compassion, and dedication. 

Adheres to TMC’s organizational and department-specific safety and confidentiality policies and standards.

Performs other related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:   Associate 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.

KNOWLEDGE, SKILLS AND ABILITIES: 

·         Knowledge of federal and state requirements as related to healthcare compliance.

·         Knowledge of electronic medical records systems, specific experience with EPIC beneficial.

·         Basic knowledge of medical terminology and coding including familiarity with ICD-10 and HCPCS codes.

·         Proficiency in Microsoft Office, including Word, Excel, PowerPoint, and Outlook.

·         Ability to prepare detailed reports and correspondence.

·         Ability to maintain professional working relationships and communications with providers, clinical staff, office staff, and administrators.

·         Ability to effectively present information and respond to inquiries.

·         Ability to define problems, collect data, establish facts, and draw valid conclusions.

·         Ability to listen and accurately interpret others' communication or instructions to take appropriate action.

·         Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

·         Ability to resolve conflict using judgment, tact, and diplomacy.

·         Ability to write correspondence and effectively present information in one-on-one and small group settings.

·         Ability to work effectively and efficiently with minimal supervision.

·         Ability to identify problems and recommend operations solutions.

·         Ability to analyze, interpret, prepare, and present reports to management.

·         Ability to accurately perform multiple tasks and observe strict deadlines.