Risk Compliance Specialist | Quality | Full Time

The Risk & Compliance Specialist assists with carrying out the Hospital’s risk management and compliance activities, which includes but may not be limited to day-to-day review and analysis of safety event data, initiating and facilitating investigations and actions to enhance patient safety and quality and minimize loss to the hospital, participating in internal audits of processes and practices to verify compliance, providing guidance on compliance matters, review and resolution of patient complaints and grievances, and overseeing contracts and policies.  This position coordinates activities to evaluate and ensure compliance with legal requirements, accreditation standards, and CMS Conditions of Participation.  This position also serves as a liaison to the general and professional liability insurance carriers and legal counsel for risk management, patient safety, compliance, claims, and legal matters.

Responsibilities/Duties:

• Prepares Risk Management reports and updates to department and senior leaders and Quality Operations Council of the Board to ensure understanding of risk management and compliance issues and resolutions to prevent reoccurrence.
• Participates in internal audit teams and disseminates the results of internal audits and corrective action plans.
• Assists the Director of Risk Management & Compliance with intake of safety event reports, privacy, and other related issues daily, along with conducting investigations and preparing resulting reports as required
• Administers the hospital’s policy and contract management systems
• Receives and works with Materials Management and the department leader to act on medical device recalls.
• Participates in Quality Operations, Internal Audit, Corporate Compliance, Environment of Care, Security, Patient Complaints and Grievances, and other committees to identify and resolve risk management and compliance concerns
• Conducts and reports on periodic sanctions checks for all employees, contractors, and vendors to ensure that all individuals and entities have not been excluded from participating in federally funded programs
• Visits departments to perform risk assessments and conduct safety rounding
• Assistance with claims investigation, management, and litigation as needed.
• Facilitates Apparent Cause Analysis (ACA), Root Cause Analysis (RCA), and Failure Mode and Effects Analysis (FMEA).
• Assists Patient Experience in investigating, resolving, documenting, and reporting patient and visitor complaints and grievances in a timely and professional manner, including direct communication with complainants.
• Demonstrates strong knowledge of healthcare compliance laws and regulations (e.g.,42 C.F.R. part 2, HIPAA, Medicare, Medicaid, Anti-Kickback, and Fraud and Abuse laws, False Claims Act) to coordinate an effective Compliance Program.
• Facilitates the action plan follow-through of risk management and corporate compliance audit findings.
• Assists with the development and implementation of initiatives, policies, and procedures, including staff education activities, regarding corporate compliance and its related activities to prevent illegal, unethical, or improper conduct.
• Guides how to respond to requests from law enforcement, attorneys, and courts.
• Assists in the monitoring of US healthcare compliance laws, regulations, and enforcement, and evaluates how changes impact the hospital
• Other duties as assigned.

Education/Experience:

 Required:

• Three years of experience in healthcare or in a position outside of healthcare with general knowledge of or experience in risk management, compliance, auditing, compliance, claims, quality, safety, or law

Preferred:

• Five years of experience in healthcare or a related field
• Associate or bachelor’s degree in healthcare or a related field
• Knowledge of performance standards of accreditation agencies, CMS, and other regulatory agencies
• Prior experience with ACA, RCA, FMEA, and other investigative and process improvement tools
• Knowledge and understanding of risk management, safety, legal, and compliance issues
• Licensed RN or certification in patient safety (CPPS), healthcare risk management (ARM or ASHRM), or compliance (CHC, CHPC)
• Knowledge and understanding of hospital event/occurrence reporting systems and processes