Risk and Compliance Specialist (req 100767)

Description

GENERAL RESPONSIBILITIES:

The Risk and Compliance Specialist works closely with the Director of Risk Management and Corporate Compliance (DRMCC) to ensure the Board of Directors, management team, and employees are in compliance with the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets the Standards of Conduct.  Additionally, the position assists to coordinate the organization's efforts to minimize Risk and any potential liability that may threaten the success of the organization.

SPECIFIC RESPONSIBILITIES:

Administration

• In working closely with other management team members, is able to collate information about and report on the status of organizational areas that may have a positive or negative impact on Health Center operations.
• Maintains a solid knowledge base and can easily share information about regulatory mandates, risk management, HIPAA, corporate compliance and other relevant organizational Risk and Compliance priorities and regulatory mandates.
• Understands HRSA (Health Resource Services Administration), Joint Commission, OASAS (Office of Addiction Services and Support), OMIG (Office of Medicaid Inspector General), NYS Justice Center, NYS OIG (Office of Inspector General), and SAM (System for Award Management) Risk Management and Corporate Compliance requirements.
• Prepares Risk and Compliance information to draft educational communications or materials, and to prepare reporting to all staff, management and the Board of Directors on a quarterly, annual and ad hoc basis.
• Serves as a subject matter expert pertaining to Risk and Compliance questions, concerns, etc.
• Acts with delegated authority from DRMCC for all Risk and Compliance matters.

Risk Management

• Educates and coaches management team members and all staff to ensure timely and accurate incident reporting.
• Initiates the follow up of incident reporting by conducting investigations and determining final resolution.
• Determines the need for, and coordinates Root Cause Analyses and concludes with reporting to appropriate authorities, including the Board of Directors if indicated.
• Develops trending and other analysis of incident reports and prepares routine reports for management staff and Board members.
• Accepts legal requests, subpoenas and warrants, and works with identified programs to prepare appropriate and complete responses within identified deadlines.
• Understands the role of HRSA and FTCA and supports the annual redeeming application process.
• Is sensitive to, and responds to, day-to-day activities that have the potential to result in a claim or lawsuit and acts accordingly to mitigate risk to the organization.
• Understands the complementary role of the commercial market liability insurers.
• Coordinates the timely updating and filing of policies and procedures with management team members to ensure they are accurate and easily accessible to all employees.
• Collates information needed for Professional Practice Evaluation activities and coordinates the process across the various specialty departments.
• Partners with the Quality Department and all programs to respond to patient grievances in a timely, thoughtful and thorough manner. 
• Initiates response and follow up to all risk related grievances, investigations, root cause analyses, regulatory agency reporting and regulatory corrective action processes.
• On a formal and on an informal basis, consistently educate staff, management and Board members about risk within the organization.

Corporate Compliance

• Coordinates the routine OMIG, OIG and SAM exclusions monitoring of staff and vendors.
• Coordinates annual certifications of the compliance program.
• Participates in organization-wide preparation for regulatory surveys, including HRSA, DOH, OASAS, Joint Commission, and others, in order to ensure successful reviews.
• Initiates response and follow up to all investigations of potential corporate compliance submissions from programs or staff and supports the non-intimidation/non-retaliation policy.
• Initiates investigation and reports for all compliance related grievances, investigations, audits, and regulatory agency reporting.
• Maintains a schedule relative to required compliance activities including but not limited to audits, contract renewals, and site visits and ensures the timely and accurate completion of the requirements.
• Supports the DRMCC and credentialing vendor for new appointments as well as reappointments and for provider privileging.
• On a formal and on an informal basis, consistently educate staff, management and Board members about compliance within the organization.

Miscellaneous

• On a formal and on an informal basis, consistently educate staff, management and Board members about ethics within the organization.
• Demonstrates excellence in both internal and external customer service.
• Understands and is able to effectively communicate HIPAA compliance, corporate compliance and client confidentiality.
• Ensures and/or remains in compliance with local, state, and federal regulation, i.e. DHHS, HRSA, NYS OASAS and NYS DOH.
• Adheres to the National Patient Safety Goals as defined by the Joint Commission and Whitney M. Young Jr. Health Center.
• Completes other duties as assigned.

Requirements

MINIMUM QUALIFICATIONS:

Bachelor's Degree.  Minimum of 1 year experience in a compliance and/or risk position to include demonstrated leadership experience. Knowledge of operational, financial, quality improvement, risk management and human resource procedures and regulations.

PREFERRED QUALIFICATIONS:

Bachelor's Degree in a health care/management discipline.  Three years' experience in compliance and/or risk.  Three years' experience in a healthcare environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected status.

Salary range: $62,000 - $72,000 annually