Description:
Job Summary
Reporting to the Compliance Manager, the Compliance Associate supports the organization’s adherence to regulatory guidelines through education, provision of information, and auditing.
Areas of regulatory oversight provided by this role include the care planning process, documentation of participant assessments, communication, and other activities; service delivery, and provision of services, to name a few.
With a strong attention to detail and thorough knowledge of regulatory requirements, the Compliance Associate creates structures and facilitates processes which support the delivery of high-quality care for PACE participants. Strong written and verbal communication, administrative, and organizational skills, and the ability to maintain a realistic balance among multiple priorities are necessary.
Duties/Responsibilities
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Serves as internal subject matter expert on all regulations and laws governing PACE operations; remains current with changes in regulations.
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Creates and maintains policies that reflect regulatory guidelines. Assists in the development of new policies, procedures, and workflow changes due to new rules, legal requirements, etc.
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Works with Senior Director of Compliance and Analytics to update and improve existing policies and procedures
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Performs audits of participant charts to ensure compliance with PACE metrics, CMS and DOH regulations.
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Provides feedback to staff on results of internal audits, identifying areas where improvement is needed.
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Reports compliance data to leadership, highlighting trends, risks, and solutions.
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Serves as project manager for compliance improvement related projects for all areas. Integrates work into Quality Improvement Initiatives
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Collaborates with interdisciplinary teams to foster a culture of accountability and continuous improvement. Identifies compliance and quality issues that emerge in team and care plan meetings and advises IDT members on necessary action steps.
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Educates and trains staff on regulatory requirements as related to participant documentation and provision of services.
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Is an active member of Risk Management, Quality Committee, and other committees as delegated.
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Conducts investigation into compliance and quality related allegations, documents investigations and outcomes in timely manner, reports outcomes to appropriate parties.
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Assists in conducting periodic mock audits of all sites.
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Serves as backup to the Sr. Director of Compliance & Analytics in monitoring and responding to issues reported through the Compliance Hotline.
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Produces CMS Universes as directed and when required by CMS, ensures thoroughness and accuracy.
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Assists in the development of corrective action plan(s) and monitors implementation post survey (ex. CMS, RIDOH, etc.)
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Contributes to the development and maintenance of an organizational audit-readiness plan in anticipation of CMS Survey.
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In collaboration with Sr. Director of Compliance & Analytics and managers of core IDT members, ensures compliance requirements are met related to care plans, assessments, SDRs, grievances, RCA-event reporting, etc.
- Demonstrates knowledge and understanding of all key regulatory statutes that impact PACE-RI as well as internal policies and procedures that relate to the IDT and provision of services.
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Assists staff in the resolution of participant grievances; resolves assigned grievances within regulatory timeframes.
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Monitors compliance with SDRs, ensures approved services are provided and all documentation is complete and accurate.
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Runs and distributes reports of compliance indicators.
- Demonstrates proficient use of electronic health record.
- Performs other related duties as required and assigned.
Requirements:
Required Skills & Abilities:
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Ability to maintain confidentiality
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Ability to prioritize tasks
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Proficiency with MS Office Suite or similar software
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Proficiency with Excel; ability to produce graphs and data driven reports
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Dependable and punctual with ability to maintain consistent attendance
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Ability to read, write and comprehend English
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Ability to maintain sound judgement under stress and communicate effectively
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Strong knowledge of CMS regulations and healthcare compliance standards, preferred.
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Exceptional organizational, analytical, and communication skills.
Education Requirements
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Bachelor’s degree required
Physical Requirements
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Must be able to tolerate prolonged periods sitting at a desk and working on a computer.
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Must be able to lift up to 10 pounds and at times up to 20 pounds.
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Must be able to navigate various departments of the organization's physical premises as well as related community care settings.
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Must be able to tolerate conditions typically associated within a medical office and/or home care setting including potential exposure to bloodborne pathogens and infectious diseases.
Experience
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1 to 3 years of healthcare compliance or quality experience, Preferred
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1 to 3 years of EMR Experience, Preferred
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1 year of experience working with a frail or elderly population, Preferred
License & Certification Requirements
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Certification in Health Care Compliance (HCCA) preferred
Position Requirements
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Driver's License & access to reliable transportation: community-based travel required.
Management Responsibility: No
Time & Attendance Responsibility: No
