- Assist in maintaining an effective Compliance Program as directed by Director of Compliance/Privacy Officer
- Regularly review State and Federal laws, rules, and notify internal business partners of applicable changes to ensure organizational compliance is maintained
- Maintain policy and procedure repositories to ensure timely review
- Track and coordinate all internal communication and document retrieval for audits; support internal customers with gathering documentation for credentialing, provider enrollment, contracting, and other requests
- Identify, track, and trend in auditing to ensure proactive preparation for future audits and/or determinations resulting in CAPs
- Draft Corrective Action Plans (CAP) and Audit Appeals with input from applicable internal business leaders and Compliance Leadership in response to audit findings
- Maintain electronic audit resource library to ensure up-to-date documentation
- Investigate Critical Incidents with appropriate internal business partners and notify agency caseworkers/contacts according to contractual and regulatory obligations
- Investigate and respond to Grievances received from clients, agencies, and third parties; provide any required follow-up education to employees or leaders; collaborate with leadership to determine and implement corrective actions
- Perform exclusion checking for new vendors to meet the Office of the Inspector General requirement and review any findings; communicate results to business leaders; evaluate unfavorable findings and collaborate with Director for further action
- Participate in trainings and provider meetings required by agencies, health plans, and Managed Care Organizations and disseminate relevant information
- Compile compliance metrics and analyze results for ongoing tracking; report metrics to the Director/Compliance Officer for Board and Executive review
- Manage general compliance email with support from broader team
- Execute regular Compliance Program Self-Assessments based on the Department of Justice recommendations
- Provide employee compliance education including onboarding, annual training, both departmental-specific and role-based training; participate in annual education review and as rules and regulations change; develop Compliance Tips for general education
- Participate in compliance audit program by planning and conducting second line of defense compliance audits with review/guidance of Director
- Develop, implement, and maintain an effective Privacy Program as directed by the Privacy Officer
- Maintain policy and procedure repositories to ensure timely review
- Complete a regular review of policies and procedures to maintain alignment with applicable state and federal privacy regulations, including HIPAA
- Review and investigate impermissible use/disclosure reports; provide employee re-education
- Participate in breach notification process
- Review and respond to individual requests based on specific state regulations, client requests for information, and third-party request for information within required regulatory timing
- Develop and provide employee privacy education including onboarding, annual training, both departmental-specific and role-based training; participate in annual review education review or as rules and regulations change; Privacy Tips for general education
- Participate in department HIPAA Auditing/Monitoring Plan and annual revision; privacy aspects of HITRUST; monitoring of program using OCR Audit Protocol
- Act as an internal compliance/privacy resource for Mom's Meals employees
- Engage in ongoing education and professional development to increase compliance expertise, business acumen, and regulatory knowledge
- Collaborate with teammates, leadership team, and internal business partners to produce effective compliance and privacy program outcomes
- Bachelor's degree in business or healthcare related field OR 4 years relevant experience
- 2 - 4 years' experience in auditing, payer relations, compliance, privacy, information security or other relevant healthcare industry experience
- Strong problem-solving skills to include developing and analyzing options and recommending solutions
- Ability to prioritize (and re-prioritize) projects in a fast-paced work environment
- Effective written and verbal communication skills
- Ability to work collaboratively to foster trust, credibility, and understanding
- Ability to promote teamwork within department and organization
- Effective personal organizational skills to meet deadlines, complete work assignments and projects and/or accomplish time sensitive work prior to due dates
- Maintain working knowledge and understanding of various state/federal compliance and privacy laws, rules and regulations related to Medicare/Medicare Advantage plans, Medicaid, Managed Care Organizations
- Proficient in Microsoft Office Applications including Word, Excel, PowerPoint, and Outlook
- Certification in compliance, privacy or other relevant area
- Repetitive motions that include the wrists, hands and/or fingers
- Sedentary work that primarily involves sitting, remaining in a stationary position for prolonged periods
- Visual perception to perform job including peripheral vision, depth perception, and the ability to adjust focus
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Compliance Specialist II - Ankeny, United States - Mom's Meals, a PurFoods Company
Description
Job Description
Position SummaryThe Compliance Specialist II is responsible for supporting the Director of Compliance/Privacy Officer in implementing and executing the compliance program within Mom's Meals. Duties include managing payer audits, privacy, grievance, and critical incident reporting. Successful candidates contribute to a positive culture of compliance at Mom's Meals.This position is hybrid (3 days/week in the office) so the candidate must be local to the area and will work onsite the first 30 days for training. Position Responsibilities may include, but not limited to
Mom's Meals is a home-delivered meal service providing fully prepared, refrigerated meal solutions direct to homes nationwide for over 25 years. We provide seniors, patients recovering post-discharge and those managing a chronic condition with tailored nutrition solutions to manage their specific needs. If you are passionate about the well-being of others and have a strong sense of community, Mom's Meals could be the place for you We are a family operated business looking for fun, compassionate, and friendly people who want to make a difference in the lives of others.
EEO
Mom's Meals complies with all applicable federal and state non-discrimination laws. All qualified applicants shall receive consideration for employment without regards to race, religion, national origin, ancestry, color, gender, age, disability, sexual orientation or military status.
