Compliance & Risk Specialist
Employment Status: Full-Time
Department: Quality and Safety
***Primary Work Location: Hayward, WI***
The Compliance & Risk Specialist assists with keeping the Hospital in a constant state of survey readiness by preparing, facilitating and coordinating survey activities within the organization. The Compliance & Risk Specialist will implement system-wide activities to evaluate and improve adherence to the accrediting body’s standards and CMS Conditions of Participation (CoPs). The mitigation of regulatory compliance risk will at all times focus on assuring the delivery of safe patient care.
The Compliance & Risk Specialist also assists with the implementation and monitoring of the risk management program. These include: occurrence investigation; facilitating the root cause analysis process and other proactive risk assessments; and the maintenance of the online occurrence reporting system. This position also assists with investigations of complaints and grievances.
Responsibilities and Duties:
Coordinates Memorial Medical Center / Hayward Area Memorial Hospital & Water's Edge Departmental Improvement Efforts
- Keeps informed of pending industry changes, trends, and best practices and assesses the potential impact of these changes on organizational processes.
- Provides reports and updates to leaders and executives to ensure understanding of readiness and vulnerabilities.
- Manages/assists in ongoing and comprehensive risk assessment to identify compliance gaps that need to be resolved or mitigated.
Develops and Supports Organizational Continuous Survey Readiness
- Collects, analyzes and reports data in support of continuous readiness activities.
- Interprets relevance of standards in relation to hospital and clinic policies and practice.
- Assists department leaders with development and implementation of internal audits to measure the effectiveness of new processes or action plans, including the design of audit tools, sampling methods, and the collation and display of data for analysis.
- Performs concurrent and closed medical record review audits to assist in determining compliance with accreditation and regulatory requirements.
- Serve as a resource for interpretation of regulatory, accreditation and disease-specific care certification standards (as applicable).
- Tracks deadlines for all regulatory/accreditation activities, assuring that all responses are on target to meet deadlines, and if they are not, that activities are escalated to meet necessary compliance timeframes.
Supports Organization’s Risk Management Program
- Facilitates reporting, tracks trends, and analyzes all safety events with the objective of enhancing and promoting patient safety and quality of care.
- Provides assistance with claims investigation, management, and litigation as needed.
- Assists with the development and implementation of initiatives, policies and procedures, including staff education activities, regarding risk reduction/elimination throughout the organization.
- Facilitates root cause analyses (RCA) and proactive risk assessments (e.g., FMEA).
- Assists in investigating, resolving, documenting, and reporting patient and visitor complaints and grievances in a timely and professional manner, including direct communication with complainants.
Supports Organization’s Corporate Compliance Program
- 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) in order to coordinate an effective Compliance Program.
- Facilitates action plan follow through of 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.
Qualifications and Skills:
- Minimum of five years’ experience working in the healthcare field.
- Knowledge of performance standards of accreditation agencies, CMS, and other regulatory agencies is preferred.
- Excellent communication, writing, organizational and presentation skills; demonstrates superior oral and written communication and time management skills.
- Ability to treat highly sensitive information with confidentiality and integrity.
- Ability to work independently and interdependently.
- Able to read and comprehend written materials of a complex level. (contracts, insurance regulations, government regulations and other regulatory agency documents).
- Demonstrated skills in critical thinking and problem solving and projects requiring attention to detail and specific timelines.
- Demonstrated success in managing projects.
- Prior knowledge with RCAs and proactive risk assessment tools.
- Prior knowledge of corporate compliance.
- Knowledge of hospital event/occurrence reporting systems and processes.
- Must have strong knowledge base of Microsoft Office applications and able to learn other applicable software as necessary.
Education / Licensure / Certification Qualifications:
Benefits and Salary:
MMC offers employees a competitive benefits package that includes:
*eligibility criteria must be met to participate in insurance plans. Not all employees may be eligible.
403 (b) Retirement Savings Plan
All employees are eligible to participate in the savings plan. Through payroll deductions, you can elect to contribute pre-tax and/or post-tax basis towards your retirement. We offer matching contributions for eligible employees.
Paid Time Off
MMC employees receive generous time off for vacations, illness and other personal matters.
MMC is a regional medical center that serves patients from 7 counties in northwest Wisconsin and Gogebic County in Michigan. We have more than 60 full-time physicians and specialists on-staff and over 500 employees who are dedicated to providing quality care. Our charming city of Ashland, WI is located on the shores of Lake Superior near Bayfield and the 21 Apostle Islands, and boasts a strong community, historic charm, modern conveniences and abundant opportunities for outdoor recreation. Our passion and driving force is to see the people of our community live healthy, productive lives. EOE.Apply Now