Regulatory Compliance and Risk Assessment Expert

2 weeks ago

Miami, Florida, United States Miami Beach Medical Group Full time
Job Overview

The Regulatory Compliance and Risk Assessment Expert plays a crucial role in supporting the Compliance Manager in the formulation and execution of Compliance and Risk Management initiatives. This position ensures adherence to relevant local, state, and federal regulations, as well as industry benchmarks.

Key Responsibilities:

  • Assist in the design, implementation, and evaluation of the compliance framework while promoting educational activities to inform staff about compliance standards and requirements.
  • Facilitate training sessions for new hires in Compliance & Risk Management.
  • Engage in DeNovo/Acquisition discussions and support compliance-related tasks to prepare centers for operational readiness.
  • Conduct ongoing assessments, monitoring, and audits across the organization.
  • Compile and distribute reports of findings to relevant stakeholders.
  • Identify potential risk factors and areas for enhancement.
  • Address inquiries from stakeholders to ensure alignment with applicable regulations and contractual obligations.
  • Contribute to the development and review of departmental Policies and Procedures in line with federal, state, and industry standards.
  • Assist in creating and reviewing materials necessary for capturing organizational processes, including marketing content and patient notifications.
  • Support the implementation and oversight of the Emergency Preparedness Management Plan.
  • Establish and execute protocols to mitigate incidents, grievances, and non-compliance activities throughout the organization.
  • Coordinate and provide insights for the Compliance & Risk Management Sub-committee meetings.
  • Evaluate, investigate, and respond promptly to health plan grievances.
  • Assist with the daily operations of the department.
  • Manage and report HIPAA breaches and potential fraud, waste, and abuse incidents.
  • Conduct root cause analyses, event reporting, and process improvements to reduce adverse events affecting patients, staff, and visitors.
  • Maintain the risk management information system database.
  • Review new products, systems, or processes to ensure compliance.
  • Represent the Compliance Manager in meetings as necessary.
  • Assist in coordinating all aspects of the medical claims process.
  • Perform additional related duties as assigned.

Qualifications:

  • A Bachelor's degree is preferred, or three (3) years of relevant experience in a health or regulatory setting.
  • Familiarity with Medicare and Medicaid guidelines, particularly in auditing, monitoring, anti-fraud legislation, and HIPAA Privacy Standards.
  • Certification in healthcare compliance and risk management is preferred.
  • Bilingual communication skills in English and Spanish are advantageous.

At Miami Beach Medical Group, we are dedicated to fostering an environment of mutual respect and equal employment opportunities for all applicants and employees, irrespective of race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military and veteran status, or any other characteristic protected by applicable law. We believe that diversity and inclusion among our employees are vital to our success as an organization, and we strive to maintain an inclusive workplace where individuals can thrive based on their personal merit, qualifications, experience, and job performance.

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