As a change agent and part of Grace Health, s/he will play a pivotal role in supporting the development,  and directing a high-performance healthcare risk and compliance program. This position will work closely with Directors, Officers, and other leaders to advance the internal risk and compliance reporting process for Grace Health. This individual will leverage his/her skills as a highly collaborative professional to help maintain and monitor all grant, Federal Tort Claims Act (FTCA), Patient Centered Medical Home (PCMH), Operational Site Visit (OSV), Controlled Substance (HB1), and any other key regulatory requirements that help improve health outcomes for patients and make a program impact. This includes working with  stakeholders in multiple departments and collaborating with external organizations that impact the communities within our service areas. This position has day to day responsibility to the internal healthcare risk and compliance reporting process in support of the Grace Health strategic goals. This position reports regularly to the Senior Director of Healthcare Risk & Compliance.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Supports and monitors Grace Health’s risk and compliance program.
• Assists with maintaining relevant policies, procedures, audit tools, and training related to the risk and compliance program.
• Helps to implement, and maintain a compliance plan with Key Performance Indicators, (KPIs)  based on requirements and risk.
• Researches to ensure Grace Health’s policies and practices comply with federal and state laws/regulations and follow industry guidelines to prevent illegal, unethical, or improper conduct.
• Assists with Development and management of  an annual risk and compliance calendar identifying all requirements to be completed by Grace Health, including timetables and accountability measures. Tracks training completion and prepares reports.
• Assists with investigations and monitoring of compliance with entity privacy policies.
• Assists with gathering data and resources for Grace Health’s clinical policy management workflows.
• Works with Grace Health directors to ensure day-to-day operations of the program are established and are executed according to compliance plan.   Partners with teams and staff to identify areas where risk and compliance input and guidance are required.
• As directed, in accordance with the risk and compliance program and plan, monitors clinical activities and conducts systematic audits for both risk and compliance with applicable rules and regulations to include HIPAA, Accreditation, CMS, and HRSA Compliance Manual.
• Assists with gathering data/documentation necessary when (applying/redeeming/re-certifications) for FTCA and PCMH.
• Communicates updates and changes on regulatory and legal changes including HRSA Compliance 
• manual, FTCA, PINs, and Pals as directed.
• Responsible to participate in team-based preparation for HRSA OSV reviews, review preparation, coordination and follow-up.
• Develops and maintains an understanding of Federal, State, and local laws and regulations that impact Grace Health’s ability to provide patient care.
• Helps to continually identify company and event-based risk.
• As part of the risk and compliance program, provides department, organization, and board dashboards.
• Assists with Incident Reporting process and staff training for Grace Health. Ensures incident reports are accurate and responded to in a timely fashion. Through regular reports and dashboards, keeps Grace Health’s directors and officers updated on trends, concerns, and areas of improvements.
• Assists with ensuring the Grace Health Safety and Emergency Preparedness Team are educated on applicable compliance standards for FQHCs, HRSA, State Medicaid, and Medicare.
• Assists with compliance investigations as directed.
• Consults with general counsel as needed to resolve challenging legal compliance issues as directed.
• Assists with claims management for the organization.  Compiles and responds to all requests for claims related information as directed.  Works with local legal counsel to ensure timely and complete cooperation with the Department of Health and Human Services (DHHS) related to claims. 
• Assists with contract review and contract management.
• Perform other related duties as assigned by the Senior Director of Healthcare Risk & Compliance

OTHER ESSENTIAL DUTIES and RESPONSIBILITIES:

• Grace Health recognizes that managing patient care is a team effort that involves clinical and non-clinical staff.  All employees must embrace a team-based approach to patient care and understand that each role is important to our success. 
• Team members must demonstrate excellent team communication and coordination to provide quality patient care.
• Care coordination includes communicating with community organizations, health plans, facilities, and specialists.
• Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by this practice. 
• Team members must demonstrate skill and knowledge related to effective communication with vulnerable patient populations.
• Team members must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high quality care.
• All team members will be involved in the process of improving quality incomes.
• Team members will participate in the review and evaluation processes of practice performance and help to identify opportunities for improvement.
• Team members will participate in Grace Health's advocacy program.

GENERAL DUTIES:

• Follows policies and procedures of the office, including administrative, clinical, quality assurance, and personnel
• Maintain good attendance (daily, meetings, and other assignment tasks)
• Maintain timely documentation of all work assignments
• Maintain patient confidentiality
• Routinely keep supervisor informed about attendance and job assignments
• Flexible in being able to keep up with multiple projects.
• Work effectively and at an efficient pace
• Work cooperatively with providers, administration, and peers

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS:

• Intermediate-Advanced Computer skills – Microsoft Office (Word, Excel, PowerPoint, and Outlook).
• Clear and concise interpersonal and verbal communications skills and the ability to communicate effectively with a variety of personnel at all levels both internally and externally.
• Sound judgment and strong commitment to ethical conduct and integrity.
• Strong problem-solving skills with the ability to identify relevant risks and propose solutions that consider relevant business objectives and compliance concerns.
• Ability to work independently in a fast-paced and dynamic environment.
• Strong attention to detail, excellent organizational skills, and the ability to work on multiple projects with tight timelines.

EDUCATION and/or EXPERIENCE: 

• Paralegal preferred
• Degree in a field of HealthCare preferred
• Experience in compliance and/or risk management in healthcare is a plus
• Working knowledge of HIPAA, HRSA, FERPA, CMS, False Claims Act, Anti-Kickback, OIG and state regulations helpful

Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.