Compliance and Risk Management Professional

4 weeks ago

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

The Compliance and Risk Management Specialist is responsible for assisting the Compliance Manager with the development of Compliance and Risk Management Programs and monitors its implementation in compliance with applicable local, state, and federal regulations, and industry standards.

Key Responsibilities:

  • Assist with developing, implementing, and evaluating the compliance program and promoting training activities to train the company staff about the corporate compliance plan, standards, and requirements.
  • Conduct training and education for Compliance & Risk Management new hires.
  • Participate in DeNovo/Acquisition meetings and assist with all compliance-related tasks to ensure the center is ready for opening or ongoing business.
  • Perform Center Assessment Surveillance, monitoring, and auditing throughout the organization.
  • Prepare the report of findings to disseminate to the stakeholders.
  • Identify risk areas and areas for improvements.
  • Respond to stakeholders' inquiries to ensure business operations are in compliance with applicable regulations and contractual agreements.
  • Support in the development/review and oversight of departments' Policies and Procedures in accordance with federal, State, and industry standards.
  • Assist in the development/review of programs and other materials needed to capture organizational processes such as marketing materials and patients' notifications.
  • Assist in the implementation and oversight of the Emergency Preparedness Management Plan.
  • Identify and implement protocols to prevent incidents, grievances, and other non-compliant activities throughout the organization.
  • Coordinate and provide input in relation to the Compliance & Risk Management Sub-committee meeting activities.
  • Assess, investigate, and respond timely to health plan grievances.
  • Assist with the daily workflow of the department.
  • Managing and reporting HIPAA breaches and exposures and reports of possible fraud, waste, and abuse.
  • Conduct root cause analysis, event and data reporting, and process improvement to eliminate/mitigate adverse events to patients, employees, and visitors.
  • Maintains risk management information system database.
  • Review all new products, systems, or processes to ensure compliance.
  • Attend meetings on behalf of the Compliance Manager as needed.
  • Assist with coordination of all aspects of the medical claims process.
  • Performs other related duties as assigned.

Requirements:

  • Bachelor's degree preferred or three (3) years of work experience with an emphasis in a health/regulatory environment.
  • Knowledge of Medicare and Medicaid guidelines with emphasis in auditing, monitoring, anti-fraud laws, and HIPAA Privacy Standards.
  • Certification in health care compliance and risk management preferred.
  • Bilingual communications: English/Spanish preferred.

Clinical Care Medical Centers is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and employees without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military and veteran status, and any other characteristic protected by applicable law.

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