Patient Experience and Compliance Manager

Job Description

Job Description

Position Summary :

Triad Adult and Pediatric Medicine Inc. (TAPM) Patient Experience and Compliance Manager is responsible for hiring, training, and establishing goals for the call center representatives to follow and resolving patient / customer issues. This position will work with patients to evaluate and monitor their experience with the practice including, but not limited to handling patient complaints, grievances, and potential HIPAA / confidentiality concerns.

The Patient Experience and Compliance Manager will work closely with the Chief Operating Officer and Chief Executive Officer to ensure policies and procedures remain within the industry regulatory framework. This position will have the duty to TAPM to identify and manage patient experience while promoting TAPM core values and customer first culture. Will also serve as the HIPAA Compliance Officer.

Primary Job Responsibilities :

• Facilitates, evaluates, and monitors patient experience / satisfaction and maintains the patient engagement survey process.
• Manages call center specialist and ensures adequate and proper phone etiquette training on a regular basis.
• Monitors call center volume and produces reports regarding calls received, calls abandoned, calls answered and the quality of service the customer receives.
• Enhances patient communication plan as it aligns with care messaging system and other patient satisfaction / experience platforms.
• Understands the scheduling and sliding fee process to effectively manage the call center staff. Assists and schedules the initial new patient appointments for newly enrolled patients as needed.
• Facilitates the process for monitoring, processing, and scheduling new patients from online patient portal.
• Ensures patient demographic, insurance and pertinent information is updated with each phone encounter.
• Establishes quality checks for call center processes (watching no show and cancellation trends) to maximize provider appointment schedules.
• Understands and educates patients regarding insurance plan options, coverage details, benefits, enrollment processes, resources, and available TAPM services.
• Serves as the HIPAA Compliance Officer.
• Reviews and prepares monthly, quarterly, and annual reports on patient grievances, complaints, HIPAA violations and / or breaches, etc.
• Works closely with the Director of Clinical Quality and Risk Management services to address any potential liability, risks and / or compliance issues.
• Prepares, monitors, and updates BOA’s (Business Associate Agreements)
• Trains staff as needed on HIPAA compliance and confidentiality.
• Educates staff and patients on TAPM’s patient complaint and grievance policy and how to submit concerns.
• Works closely with TAPM’s Marketing Department to address online reviews and concerns. Reports outcomes to Senior Management and develops a plan for improvement.
• Ensures TAPM remains in compliance with all outside regulatory and legal requirements, as well as internal policies and bylaws.
• Review and set standards for outside communication by requiring disclaimers in emails or examining facilities to ensure they are accessible and safe.
• Ability to travel as needed.

Education :

Bachelor's degree in health-related field, master’s degree a plus, or advanced clinical licensure.

Certification in Healthcare Quality Management or Risk Management and / or HIPAA Compliance. A combination of education and experience may be considered.

Experience :

Minimum 3-5 years of experience in health care setting with minimum of three years’ experience in patient experience, call center, quality, and HIPAA Compliance. Familiar with state and federal compliance regulations and standards.

Knowledge :

1. Knowledge of Corporate Compliance and HIPAA

2. Knowledge of how to use computer applications including spreadsheet software.

3. Knowledge of medical records, electronic health record and clinical care processes.

4. Knowledge of patient scheduling, phone systems and call center SOP (standing operating procedures)

Abilities :

Environmental Working Conditions :

Combination of office and classroom settings. Frequent contact with patients, physicians, clinical staff, and the public.

Physical / Mental Demands :

Variety of sitting, standing, walking. Occasional stress from dealing with people who are upset.

Confidential Information :

Works with some confidential data of major importance, such as patient records, and patient / family salary / personal information, corporate financial statements, etc., which, if disclosed, may be detrimental to the company’s interests.

Safety :

TAPM expects all employees to work with safety as a priority. The safety of our employees and our patients are extremely important to our organization.

Quality Improvement

Must understand and help enforce the meaning of quality improvement : ” The combined and unceasing efforts of everyone-healthcare professionals, patients, and their families, researchers, payers, planners and educators-to make the change that will lead to better patient outcomes, better system performance and better professional development.”(Batalden, 2007). Committed to promoting TAPM as a medical home and incorporating the core components of a Patient Centered Medical Home into your position on a daily basis.

Focusing on Quality and Safety