The Quality- Compliance/HIPAA is responsible for executing the HIPAA Incident Reporting Process to ensure all data privacy events are promptly identified, thoroughly investigated, and effectively mitigated. This role acts as a critical bridge between compliance and operational teams, executing robust HIPAA Breach Assessments to determine if a formal breach has occurred and maintaining defensible documentation for all completed actions.
Major Responsibilities/Activities
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Monitor Inbound Alerts: Actively monitor the dedicated Incident Reporting Inbox and JIRA queue to identify newly reported potential HIPAA incidents.
- Meet Strict SLAs: Complete the initial review and assignment of all reported incidents within the first 48 hours of submission.
- Historical Analysis: Conduct comprehensive searches in Outlook and JIRA using run/encounter numbers to determine if an incident has been previously reported or requires updated documentation.
- Root Cause Investigation looking at Audit Billing Histories: Dig into patient accounts using proprietary billing platforms to reconstruct the history of a claim and understand the narrative of what occurred.
- Execute Risk Assessments: Populate and manage the HIPAA Breach Risk Assessment utilizing the Compliancy Group Template. Identifying the Issue, who was involved, what happened and how it was Resolved.
- Analyze Regulatory Exceptions: Methodically evaluate incidents against standard HIPAA Privacy Act exceptions to determine breach status.
- Maintain Client Folders: Organize, create, and save securely dated documentation and necessary snippets of Protected Health Information (PHI) within specific client directories.
- Action Item Tracking: Outline and log all corresponding tasks required to successfully close an incident out.
- Stakeholder Notification: Reply to original ticket submitters/groups via JIRA or email to acknowledge reports, outline the incident context (ensuring complete anonymity of employee names), and clarify outstanding next steps.
- Educational Feedback: Provide constructive feedback directly to leaders of internal users who caused the compliance issue to drive continuous workforce education.
- Operational Alignment: Partner with internal and global operational teams using the Client Matrix to coordinate complex account fixes like voids, unmerges, or claim reviews.
- Workflow Hygiene: Keep JIRA tickets updated with accurate statuses (e.g., In Progress, Done, or Done, Pending Void Acknowledgement) and confirm completion of associated Word documentation.
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Monitoring, Escalations, & Trend Identification
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Strategic Escalations: Spot atypical or severe compliance violations (e.g., physical records taken off-site) and immediately escalate them to the Compliance Director and Compliance Manager for advanced investigation.
- Trend Analysis: Identify and communicate compliance patterns or systemic trends to leadership to prompt initiative-taking updates to policies, procedures, and training programs.
Required Education, Skills, & Experience
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Bachelor’s degree in healthcare, Business, or related field or equivalent experience.
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1-3 years of direct experience in healthcare compliance and reimbursements.
- Strong, demonstrated knowledge of all aspects of healthcare compliance.
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Demonstrated understanding of the medical billing cycle and payor rules and regulations.
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Strong decision-making, problem-solving, critical thinking, and analytical skills with the ability to identify the problems and determine appropriate next steps.
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Ability to assist with developing effective educational materials and train others to achieve results.
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Willing, eager, and able to learn and interpret new laws and directives as they are issued and apply to business operations.
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Strong collaboration skills with the ability to work across department lines to achieve results.
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Highly organized with the ability to manage time, prioritize work effectively, and remain productive.
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Ability to communicate and manage sensitive information in a confident manner.
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Ability to effectively meet deadlines.
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Elevated level of accuracy and diligence.
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Proficiency in Microsoft Word, Excel, Outlook, and Power Point.
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Willing and able to adapt to changes in work environment, procedures, priorities, and job duties.
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Proficiency in English is necessary for job-related communication, including understanding policies, writing correspondence, and engaging with colleagues or clients.
Preferred Education, Skills, & Experience
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Experience building and maintaining strong relationships with key internal staff and external contacts, demonstrating credibility, and representing company values in a positive manner.
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Experience participating in and/or leading industry-related conferences, trade shows, and professional-development opportunities.
Working Environment
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The office environment is a controlled indoor setting with minimal exposure to adverse conditions.
- Noise levels in the office are typically moderate and consistent with a standard office setting.
- For employees approved to work in a hybrid or remote setting, a quiet, private workspace free from significant distractions is required to ensure productivity during work hours.
- A reliable internet connection is required for hybrid/remote work. EMS|MC will provide necessary equipment, including a computer, monitor, keyboard, mouse, and headset.
Physical Requirements:
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Sitting: frequent and prolonged periods of sitting at a desk while working on a computer.
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Communication: frequent and prolonged periods of speaking, listening, reading, and writing.
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Fine motor skills: frequent use of hands for typing and operating a computer mouse.
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Movement: Limited due to Remote work. Frequent movement is encouraged.
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Flexibility to work extended hours to support the business as required.
