Compliance Specialist

Job Title: Compliance Specialist

Reports To: V.P. of Operations

FLSA Status: Exempt

Catalyst Dental Allies (CDA) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.

Job Summary:

The primary purpose of this position is to plan, direct, and control all aspects of a successful compliance program. The Compliance Specialist is responsible for acquiring the knowledge required to develop the overall compliance program and ensure compliance is maintained throughout CDA in accordance with all government mandated regulations and laws including, but not limited to those required by the Center for Medicare and Medicaid Services (CMS), U.S. Department of Health & Human Services, the Occupational Safety and Health Administration (OSHA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and developing an audit plan to maintain compliance with those and any other required programs.

Duties and Responsibilities:

• Partners with V.P. of Operations to develop a compliance program that should include company policies and procedures on all laws and regulations required by the U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services, Occupational Safety and Health Administration (OSHA) requirements and regulations, Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements and regulations, and all other local, federal and state laws and regulations that affect or could affect a dental clinic.
• Communicates compliance program to all employees.
• Monitors compliance with federal, state and local regulatory requirements and remains informed of changes to laws and regulations that may affect the organization's policies and procedures.
• Reviews compliance program on a regular basis and make updates, as applicable, based on the needs of the organization and/or changes in regulations and requirements.
• Creates, initiates, maintains, and revises policies and procedures for the general operation of the compliance program and its related activities to prevent illegal, unethical, or improper conduct.
• Acts as point of contact for safety incidences and/or adverse events and is responsible for documenting, submitting, and resolving such safety incidences and/or adverse events.
• Manages day-to-day operation of the compliance program.
• Supports and upholds established policies, procedures, objectives, quality improvement, safety and compliance requirements of accreditation and regulatory agencies.
• Identifies potential areas of compliance vulnerability and risk, develop and implement corrective action plans for resolution of problematic issues, and provide general guidance on how to avoid or deal with similar situations in the future.
• Conducts and coordinates internal and external compliance audits and reviews, to include OSHA audits, HIPAA audits, provider chart audits, billing chart audits, as well as other audits as needed, required, or requested. Responds to incidents of suspected compliance violations and takes appropriate actions as approved by V.P. of Operations.
• Responds to insurance and government audits and queries as applicable.
• Provides reports on a regular basis and, as directed or requested, keeps V.P. of Operations informed of the operation and progress of compliance efforts.
• Maintains records of all reports, problems, and questions for review and reporting to V.P. of Operations.
• Attends educational seminars/meetings and reports information gathered to V.P. of Operations.
• Develops and coordinates staff training and monitors staff attendance for compliance programs with HR.
• Maintains current knowledge about government and industry regulations and standards for the conduct of business.
• Detects, investigates, prevents, and corrects operational deficiencies relating to governmental and industry regulations and standards. Ensures corrective action plans are in place to resolve any identified compliance issues.
• Provides timely feedback to employees and others on compliance issues.
• Maintains an effective reporting system to provide a uniform way for questions to be raised or potential non- compliance to be reported.
• Ensures patient confidentiality and follows HIPAA guidelines.
• Displays the Catalyst values of Passionate, Adaptable, Integrity, Ally, and All-In.
• Other duties as assigned.

Scheduled Working Hours:

Scheduled work hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. Hours may vary depending upon the needs of

the position, department, and business.

Other Duties:

Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.

Equipment Operated:

Standard office equipment including: computers, printers, faxes, copiers, postage machine, calculator, etc.

Skills and Qualifications:

• Bachelor’s degree in healthcare related field, preferably in healthcare administration or health information management.
• 5 years dental and/or medical billing experience in an administrative and/or supervisory capacity.
• Knowledge of federal, state, and local laws and regulations pertaining to the operation of a private clinic.
• Broad-based knowledge of relevant insurance regulations and familiarity with the Health Insurance Portability and Accountability Act (HIPAA).
• Understanding of coding and reimbursements systems, risk management, and performance improvement.
• Able to focus on results, meet deadlines, and promote highest standards for self and others.
• Organized and plans effectively to coordinate successful operations within the clinic.
• Identifies problems and provides solutions and alternatives.
• Adaptable and able to manage multiple priorities and coordinate work activities.
• Excellent interpersonal and communication skills; written and verbal, an ability to influence and motivate others.
• Disciplined in timely reporting and follow up with team members and administrative office.
• Skilled and confident in leading a diverse team of dental care professionals.
• Skilled in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.
• Skilled in exercising judgment and discretion in developing, applying, interpreting and coordinating departmental policies and procedures.
• Able to effectively maintain composure and poise under pressure.
• Able to assume responsibility and exercise authority over assigned work functions.
• Able to conceptualize work flow, develop plans and implement appropriate actions.
• Proactive and able to solve problems effectively and rapidly using excellent analytical skills.
• Proven consistently high levels of customer service performance, with an ability to build strong relationships and expand patient base.
• Flexible and adaptable to changing business needs, with an ability to support other departments and locations as needed.
• Technically skilled and knowledgeable, understands how position relates to the clinic organization.
• Able to resolve conflict, maintain appropriate work relationships, and collaborate with others.
• Communicates effectively, can respond to difficult questions, and is a good listener.
• Enjoys new opportunities and is passionate about patient care.
• Knowledge of customer service and telephone technique.
• Knowledge of dental terminology and procedures, dental fee schedules, basic accounting, and staff supervision.
• Knowledge of dental insurance, predeterminations, computer skills including Eaglesoft, Dental Intel, Open Dental, Dentrix, Fuse, and/or other dental practice management software.
• Must have a valid driver’s license to drive to dental clinics in region.
• Physical Requirements:
• Physical ability to withstand the stress and demands of an active position.
• Physical ability to sit, stand, walk, stoop, bend, perform data entry, and view computer screen for long periods of time.
• Good manual dexterity, eye-hand coordination, vision, and hearing.
• Occasional exposure to communicable diseases and biohazards.
• Occasional exposure to toxic chemicals, radiation, and increased noise levels.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Physical Requirements:

• Physical ability to withstand the stress and demands of an active position.
• Physical ability to sit, stand, walk, stoop, bend, perform data entry, and view computer screen for long periods of time.
• Good manual dexterity, eye-hand coordination, vision, and hearing.
• Occasional exposure to communicable diseases and biohazards.
• Occasional exposure to toxic chemicals, radiation, and increased noise levels.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel:

Travel will be required.