Regulatory Specialist - Morgantown, United States - WVU Medicine

Description

The Regulatory Specialist will be responsible for a wide range of duties related to regulatory compliance, data analysis, stakeholder collaboration, system management, and program implementation in the healthcare setting. This position will be responsible for analyzing, implementing, and maintaining quality and regulatory reporting which ensures compliance with regulatory requirements. In addition, this position will be responsible for providing context to systems analysts for appropriate build efforts to support regulatory requirements for successful extraction of data from the EHR.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's Degree in Nursing, Healthcare Information Technology, Business, Finance, Regulatory Affairs or related discipline AND two (2) years' experience in regulatory industry encompassing comprehensive understanding of prevailing programs and legislation, crucial for facilitating quality reporting and incentive payment programs

OR

High School Diploma AND four (4) years' experience in regulatory industry encompassing comprehensive understanding of prevailing programs and legislation, crucial for facilitating quality reporting and incentive programs.

2. Completion of clinical application certification (EMR) within six (6) months of hire.

PREFERRED QUALIFICATIONS :

EXPERIENCE:

1. Experience interpreting and applying complex regulatory requirements to IT processes/workflows.

2. Experience managing quality payment programs

3. Certification/Proficiency of EHR clinical application(s) with Regulatory Reporting emphasis

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Maintain a thorough understanding of regulatory compliance initiatives and timelines

a. Utilize CMS and other approved sources to review, understand and interpret program requirements, timelines, and incentives/penalties.

b. Coordinate, monitor, analyze, interpret and report on various performance components associated with pertinent quality reporting and regulatory programs.

c. Ensure compliance with regulatory requirements and utilize electronic health records to improve patient care.

d. Stay current with federal and state regulations, advancements in EHR systems, inventive programs and industry best practices.

e. Knowledgeable of the existing user workflows.

f. Independently oversees system configurations and design options to make appropriate recommendations for system maintenance or project decisions.

g. Continually identifies areas of opportunity for enhancement.

h. Acts as regulatory expert for the health system.

i. Clearly communicates and acts as regulatory liaison to IT and operations.

j. Conducts audits of system as required to maintain accurate reporting.

k. Maintains an understanding of supported applications.

l. Oversees and/or independently imports and exports data.

2. Coordinate Regulatory-Based IT/Information Systems Activities

a. Generate reports to track performance and identify opportunities for improvement.

b. Analyze data and prepare program reports for all entities.

c. Conduct regular audits to assess EHR functionality, data integrity, and user proficiency.

d. Ensure compliance with regulatory programs and assist in developing and implementing strategies to maximize incentive payments.

e. Identify areas for improvement in quality measures, performance, interoperability, and data analysis, and implement strategies for enhancement.

f. Serve as a subject matter expert on relevant federal legislation and regulations.

g. Provide direction of EHR build and related aspects of interoperability, including data sharing, integration and analytics to ensure EHR functionality for program implementation and provide ongoing maintenance and support.

h. Successfully submit program attestations.

i. Develop standard reports, ad-hoc analysis, and data extractions to support regulatory requirements.

j. Maintain up to date standard documentation requirements to support this role.

3. Problem Resolution and Planning

a. Anticipate and prevent issues related to new federal regulations or technology challenges.

b. Promptly identify, escalate and resolve issues as they arise.

c. Advises leadership of issues and makes recommendations for corrective actions.

4. Program Coordination

a. Demonstrate a high level of operational compliance requirements, technical skills, organizational abilities and program management skills.

b. Develops realistic work estimates, financial budgets, and program schedules.

c. Assists and mentors others involved with program planning and execution.

d. Proactively apprises management of issues affecting program status and offer solutions to solve the issues. e. Assesses appropriate work effort for a program or task and supply progress reports.

f. Review program deliverables for accuracy and provides assistance and mentoring to others.

5. Team Building

a. Leads departmental teams.

b. Coordinates team cross training.

c. Leads new regulatory and quality initiatives and shares knowledge with team members.

d. Creates presentations and/or reports.

6. Training & Education

a. Provide education and training to team members on quality improvement initiatives and program requirements.

b. Function as the primary contact to troubleshoot problems and questions from providers, administrators, end-users, and other departments.

c. Plans, develops, and implements new training curriculum and training programs partnering with training resources as appropriate.

d. Participates in strategic planning to facilitate broad organizational initiatives.

e. Provides leadership in planning, development, and direction of system training for appropriate regulatory and quality programs.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stopping, kneeling, reaching, pushing, pulling, lifting, grasping are necessary body movements utilized in performing duties through the work shift.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. The work environment is a standard office environment

SKILLS AND ABILITIES:

1. Ability to handle and maintain confidential information

2. Ability to work well under high stress conditions

3. Ability to work independently or cooperatively as team member

4. Ability to adapt to various workloads and assignments

5. Ability to work with multi-disciplinary groups and facilitate meetings

6. Possess excellent oral and written communication skills

7. Ability to prioritize tasks

8. Must have independent decision-making ability

9. Must have project coordination skills

10. Ability to mentor others