The following statements are intended to describe the general nature and level of work being performed by the individuals assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel.
Principal responsibilities of a Compliance & Quality Analyst include:
1. Serves as case investigator and performs follow-up with affiliate personnel on complaints and inquiries received through the Compliance Hotline, Quality mailbox, internal reporting, or other reporting and monitoring mechanisms.
2. Develops closing summary reports for case investigations and performs follow through to determine implementation of corrective action plans.
3. Serves as a consultant for internal and external customers related to compliance and quality of clinical care questions and collaborate with management personnel in the development of corrective action plans.
4. Prepares reports to meet the needs of the Director of Compliance, Director of Quality and UMMS executive management and the Audit and Compliance Committee of the Board of Directors.
5. Conducts audits/reviews and performs analysis to determine compliance with applicable federal and state laws, and policies and procedures.
6. Monitors data and trends to determine deficiencies and/or areas for further investigation and provides recommendations.
7. Develops and implements compliance policies as requested by the Compliance Director.
8. Carries out compliance research on specific topics such as Privacy regulations, Conflict of Interest Standards, Quality of Clinical Care , policy development and healthcare regulations.
9. Organize a methodology to auto-generate standing reports and to quickly respond to prioritized information requests.
Compliance & Quality Areas
Manages all aspects in one or more subject-matter areas of Compliance operations and works directly with Corporate Compliance Directors to implement specific components of the annual Compliance Plan. Specific Compliance subject matter areas include:
A. Compliance Administration
1. Hotline Triage intake, classification, investigation, remediation and incident resolution.
a. Leads intake for all reported incidents into Compliance Hotline, Call Center and Email Center. Triages, assigns incident category, notifies and involves appropriate affiliate or shared service team when applicable for case investigation and resolution.
b. Creates and maintains hard copy file documentation and logs into departmental tracking database.
c. Manages the follow-up process for resolving incidents according to organizational policy timeframes.
d. Develops Compliance Hotline statistical data for reporting to the Audit and Compliance Committee of the Board of Directors, the Executive Compliance Committee, the Affiliate Compliance Officer Committees and other meetings as requested.
2. Education, both general and supplemental, development, distribution and presentation. Healthcare compliance and regulatory research.
a. Analyzes, prioritizes and provides supporting research theory on researched data and summarizes in a presentable format for discussion with management.
b. Prepares departmental research reports inclusive of supporting documentation and executive summaries as applicable.
c. Identifies education and training needs across organization’s shared services and affiliates.
d. Carries out compliance special projects such as compliance internal education and training requirements, development and of training modules and loading into learning management system and annual review and revision of organizations learning portal library.
3. Policy Administration and development of committee content and follow through on action items.
a. Oversees standardized system for ensuring compliance policy implementation at each affiliate.
b. Assists in the implementation and support of the policy and procedure management process.
c. Works collaboratively with the Compliance Director in compiling agenda and materials for Audit and Compliance Committee of the Board of Directors, the Executive Compliance Committee, the Affiliate Compliance Officer Committees and other meetings as requested. Attends and take minutes as requested. Performs follow-up on meeting topic discussion when necessary.
B. Screening and Exclusion
1. Screening and Exclusion of System Groups
a. Manages the Screening and Exclusion process for all employee/staff group levels, conducting data runs from government databases, determining report matches, conducting necessary research and preparing and submitting reports to HR, Office of General Counsel and Corporate Compliance for appropriate action and resolution.
b. Conducts training regarding the Screening and Exclusion process and protocols
c. Develops and maintains Screening and Exclusion policies, tools and vendor process.
C. HIPAA Privacy and Security
a. Prepares required HIPAA breach reporting for reporting submission and enters into current government reporting system as required after review by Compliance Director.
b. Identifies and develops related HIPAA Privacy and Security education and training opportunities.
c. Collaborates with Hospital Privacy Officers and HIM staff to investigate, mitigate and resolve HIPAA Privacy related incidents.
D. Quality and Safety
a. Coordinates quality improvement activities to ensure consistency with organization policies, procedures and philosophy, and to maintain and improve the quality of care given to the patient.
b. Develops, implements and documents activities relating to the Quality Program.
c. Collects and analyzes data, conducts presentations and educational programs, and develops sustainable processes to assure coordinated care.
E. Compliance Program Metrics
1. Analyzes Compliance Program Metrics, identifies gaps and develops and reports
a. Collects documentation from Practice Managers quarterly and annually regarding their Compliance Program Metrics and assists in determining documentation is appropriate, reviews for statistical accuracy, meets standards, requests more information if required, and ensures it is complete.
F. Physician and Referral Source Relationships
1. Handles physician and referral source issues directly related to Stark law and Anti-Kickback Statute.
a. Conducts research data analysis and investigation for referral source issues.
b. Drafts management recommendations directly related to physician and referral source investigation outcomes.
c. Develops closing summary for all investigated physician and referral source issues.
d. Collects annual Disclosure of Financial Relationships (aka conflict of interest) questionnaire process. Ensure completed questionnaire timeframes are met. Develop management reports regarding questionnaire results.
Employee BenefitsAs a University of Maryland Community Medical Group (UM CMG) employee, you will enjoy a comprehensive benefits program designed with you and your dependents in mind. Subject to any eligibility waiting period, all of the benefits are available to regular full-time employees a...
Bachelors degree with a major in Health Services Administration, Mathematics, Statistics, Economics, Finance or Information Technology; 3 years of experience in scientific or data analytics is preferred
5 years of work experience in a business, professional or health care environment, including direct experience in one of the following areas: Quality, Compliance, Internal Audit, Education and Training, Case Investigations, Research or equivalent related fields is required.
Experience in data analysis for hospital, or ambulatory settings preferred.
Experience in developing dashboards, graphical display, and statistics is preferred
Experience with healthcare (medical or surgical) data analysis is preferred
Experience with EPIC, ICD 10 codes.
Knowledge, Skills and Abilities
1. Expert or very advanced Excel skills
2. Expert or very advanced SQL report composition skills
3. Advanced data analysis (“mining”) and data modeling
4. Excellent professional presentation and written communication skills.
5. Must be able to maintain confidentiality of all compliance related or other reported issues.
6. Knowledge of statistical methods and methods of graphic presentation
7. Knowledge of technical report writing procedures
8. Ability to prepare comprehensive statistical and narrative reports
9. PC literate with intermediate proficiency in Microsoft Office Suite, Visio, Internet and data analysis tools and techniques.
10. Effective verbal, written and interpersonal skills to communicate with colleagues, patients and/or visitors to establish strong working relationships.
11. Strong problem solving and decision-making skills.
12. Knowledge of risk assessments and monitoring activities related to compliance risks.
13. Knowledge to effectively communicate with health care providers at all levels.
14. Strong analytical skills.
15. Ability to work in a self-directed team by taking and giving direction and sharing in the responsibility of the team.
16. Self-motivated. Able to evaluate the scope of each day’s work and use time management and organizational skills to accomplish assignments