Role Description

This position investigates and analyzes potential breaches, privacy incidents, inadvertent disclosures, and manages and compiles documentation which occur in the Out of Network Department. This position also provides education and training to the Out of Network team members to promote and ensure compliance with relevant privacy regulations. This position is responsible for ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other federal, state, or other relevant international privacy regulations.

Qualifications

• High School Diploma or GED required; Associates Degree preferred.
• Minimum 2 years of experience in privacy, compliance, in a healthcare setting such as negotiations, claim processing, medical coding, provider billing, customer service, worker's compensation or collection agency.
• Knowledge and understanding of negotiation process.
• Strong communication (written, verbal, and listening), analytical, organizational, prioritization, technical, etiquette, and interpersonal skills.
• Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites with preferred proficiency with Word, Excel, and other database software.
• Ability to be flexible in quickly shifting priorities and keeping up with changes across multiple tasks in a fast-paced environment while maintaining a positive and cooperative demeanor.
• Ability to demonstrate strong technical skills.
• Ability to identify issues and escalate for course of action for resolution.
• Ability to elicit trust and credibility with all levels of the organization.
• Ability to adjust/alter schedule to meet deadlines.
• Ability to work independently and handle confidential information.
• Must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

Requirements

• Investigates and evaluates reported privacy incidents which occur in the Out of Network Department (OON) to determine if they are an inadvertent disclosure, if the incident(s) constitute a reportable breach.
• Investigates inappropriate disclosures or privacy breaches of PHI ensuring compliance with reporting timeline guidelines.
• Review and approve outgoing and incoming correspondence to providers ensuring complete accuracy.
• Research systems and database for historical performance and outcomes to provide analytics.
• Maintain reports that will improve quality and improve the management of workflow.
• Reports all incidents to Legal Analyst, Privacy for determination of whether an incident requires notification to clients or other regulatory bodies, such as HHS Office for Civil Rights.
• Responsible for compiling data and tracking of all investigated reported privacy incidents to report on a quarterly basis.
• Responsible for the review, maintenance and updates to existing agreements in the system.
• Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed.
• Recommend system and operation changes to improve efficiency of workflow, quality, and mitigate risk of future inappropriate disclosures or privacy breaches within the OON Department.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company’s Core Competencies and values held within.
• This role is considered to be a High Risk Role due to exposure of PHI sensitive data.

Benefits

• Medical (PPO & HDHP), dental and vision coverage.
• Pre-tax Savings Account (FSA & HSA).
• Life & Disability Insurance.
• Paid Parental Leave.
• 401(k) company match.
• Employee Stock Purchase Plan.
• Generous Paid Time Off -- accrued based on years of service.
• 10 paid company holidays.
• Tuition reimbursement.
• Employee Assistance Program.
• Sick time benefits -- for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits.