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Regulatory Compliance and Risk Analyst

2 months ago

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

The Regulatory Compliance and Risk Oversight Specialist plays a crucial role in supporting the Compliance Manager in the development and execution of Compliance and Risk Management Programs. This position ensures adherence to relevant local, state, and federal regulations, as well as industry standards.

Key Responsibilities:

  • Assist in the formulation, implementation, and evaluation of the compliance program while promoting training initiatives to educate staff on compliance standards and requirements.
  • Facilitate training sessions for new hires in Compliance & Risk Management.
  • Engage in DeNovo/Acquisition discussions and assist with compliance-related tasks to prepare centers for operational readiness.
  • Conduct ongoing assessments, monitoring, and auditing across the organization.
  • Compile and present reports of findings to relevant stakeholders.
  • Identify potential risk areas and suggest improvements.
  • Address inquiries from stakeholders to ensure compliance with regulations and contractual obligations.
  • Support the development and review of departmental Policies and Procedures in line with federal, state, and industry standards.
  • Contribute to the creation and review of materials necessary for capturing organizational processes, including marketing content and patient notifications.
  • Assist in the execution and management of the Emergency Preparedness Management Plan.
  • Establish and implement protocols to mitigate incidents, grievances, and non-compliance activities.
  • Coordinate and provide insights during Compliance & Risk Management Sub-committee meetings.
  • Evaluate, investigate, and respond promptly to health plan grievances.
  • Support the daily operations of the department.
  • Manage and report on HIPAA breaches and potential fraud, waste, and abuse incidents.
  • Conduct root cause analyses, event reporting, and process enhancements to minimize adverse events affecting patients, employees, 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 environment.
  • 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 proficiency in English and Spanish is preferred.

At Miami Beach Medical Group, we are dedicated to fostering an environment of mutual respect and equal employment opportunities for all applicants and employees, regardless 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 support an inclusive workplace where employees thrive based on their individual merit, qualifications, experience, abilities, and job performance.