Job Description
Job Overview:
Job Title | QUALITY AND COMPLIANCE OFFICER |
Reports to | DIRECTOR OF QUALITY AND COMPLIANCE |
Direct Reports | NONE |
FLSA Status: NON EXEMPT | DSP Status: NO |
This job description is intended to describe the nature and level of work being performed by employees assigned to this position. It is not to be construed as an exhaustive list of all responsibilities and duties required of the job incumbents.
GENERAL SUMMARY
Responsible to conduct, complete, report and follow up on all assigned compliance and HIPPA audits; conduct assigned Quality Assurance job tasks that include Training, Incident Investigations, and Quality Assurance programs and tasks for the JM Murray Services division
COMPANY STANDARDS
- Maintains regular attendance and punctuality in order to provide quality service to individuals served. This position may be assigned to performs work hours both onsite at JM Murray locations and/or in a remote working arrangement, based on company needs.
- Follows all safety rules and regulations; wears and/or uses required protective equipment while working; immediately reports any safety concerns or unsafe working conditions to the Director of Quality and Compliance
- Ensures all compliance and quality assurance activities are coordinated, documented and provided in compliance with the JM Murray mission statement, policies and procedures, professional standards, and applicable governmental laws, rules and regulations.
- Maintains all information, both verbal and in writing, with the utmost confidentiality.
- Demonstrate both personal accountability and the development of confidence and accountability of employees, to ensure that day to day issues and concerns are responded to and resolved in a timely manner.
ESSENTIAL FUNCTIONS
Internal Billing Audit Program
- Follows a schedule and selection of files, set forth by the Director of Quality and Compliance, to audit for each service area within the required timeframe.
- Uses the current audit tools and recommends changes to the Director of Quality and Compliance, when there are updates to OPWDD/OMH billing standards.
- Follows the procedures for Internal Billing Audits and Monthly Compliance Group meetings, including but not limited to the documentation corrective actions needed for audited files and follow up on reviews to ensure corrections are made by services leadership. Reports any trends noted, and/or if corrective actions are not being addressed to the Director of Quality and Compliance.
- Assists in preparing a quarterly summary report of internal billing audits for the Director of Quality and Compliance and the President for review prior to the Quarterly Compliance Meeting.
- In collaboration with the Director of Quality Assurance and Compliance, maintains updated knowledge of billing standards; ensure that audit tools are based on current information and updated as required.
- In collaboration with the Director of Quality Assurance and Compliance, and per established procedures, expand audit schedule and increase oversight for a particular individual or program based on emerging trends or patterns of concerns.
Compliance Committee
- Responsible for the clerical aspects of the committee, including preparation of the agenda and materials for each meeting for the Director of Quality and Compliance. Distributes in advance to all committee members. Coordinates meeting locations and any logistical needs for meeting, such as IT set up, TEAMS/WebEx, etc.
- Takes and prepares the minutes for each meeting, distributing to committee members and saving in the appropriate Compliance Folder, following JM Murray file name standards.
- Presents the quarterly summary report at Committee Meetings, and any other assigned topics.
Compliance Investigations
- At the direction of Director of Quality and Compliance, may be assigned to review service notes, service plans, billing records, time records and other documentation as part of a compliance investigations. This includes the review of records through the JM Murray Electronic Medical Record, and the efficient use of equipment such as a computer, laptop, and/or a tablet.
- As assigned by the Director of Quality and Compliance, conducts interviews and takes statements from witnesses and employees as part of a compliance investigation.
- Prepares concise, comprehensive reports and summaries of assigned documentation reviews as part of investigative summaries and reports.
Compliance and HIPAA
- Upon completion of required training, and IF required by a federal Public Health Emergency or NY State of Emergency, conducts Contact Tracing for assigned employee cases, maintaining the utmost confidentiality of all information obtained in the process.
- Conducts the annual HIPAA Risk Assessment audits. Prepares a concise and comprehensive report on the outcomes of the assessment audits.
- Assists the Director of Quality and Compliance with assigned individual compliance activities, including obtaining and collecting documentation and updating on progress.
- Provides clerical support for compliance responsibilities and initiatives including but not limited to updates to policies, consistency checks, managing and filing compliance documents, updating spreadsheets and files, preparation of training packets, mailings, etc.
- May be assigned to attend entrance and exit conferences and meetings for external audits and reviews. Collects and files compliance and HIPAA related documentation and notices.
Incident Management
- Conducts and documents incident investigations according to established procedures. Submits investigation reports that fully and accurately document the investigation process, outcomes and recommendations, within established timeframes.
- Interview alleged targets, victims, and witnesses according to established procedures as needed.
- Monitors and updates IRMA (Incident Reporting and Management Application) and WISR (Web Submission of Investigation Reporting) for all reported incidents and responds according to reports received.
- Attends and participates in Incident Review Committee meetings, as assigned. Assists the Director in the preparation of agenda, materials, etc. and with presenting information to the committee. May be assigned to complete minutes for committee meetings.
- Assists the Director, as requested, with any reporting on Incident Management, including data for trend reports.
Quality Assurance, Training, and other required tasks
- Conducts and reports on random quality assurance audits of services that are provided. Audits may include meeting with people receiving services and their families, record reviews and/or physical observation of service delivery both on and off site to ensure service environments meet the physical social, developmental and safety needs of the persons served. Observations will include monitoring that individual interests are respected and that civil, human and legal rights are protected.
- Conducts and reports on the completion of the annual satisfaction survey of service recipients. Submits annual report to the Director within an established timeframe.
- Attends and participates in Quality Assurance Committee Meetings, including assistance to prepare agenda, materials, etc. May be assigned to complete minutes for committee meetings.
- Conducts training, as assigned, for small or large groups; presents compliance topics and training at company Communication Meetings, staff meetings, etc.
- Attends all required and assigned training and meetings. As assigned, represents JM Murray as a representative on local and regional committees.
- Conducts self in a manner as to always contribute to maximum individual growth and in accordance with all regulations, the Code of Ethics and Company policy and procedures. Represents JM Murray and the JM Murray mission in a positive manner, treating people with respect and dignity.
- Performs additional duties and responsibilities, as assigned.
COLLABORATION
INTERNAL
JM Murray Staff and Management
EXTERNAL
External auditors from various state, federal agencies (example Office of People with Developmental Disabilities)
Families/consumer employers
Regional and state agency representatives
EDUCATION and EXPERIENCE
An Associate’s Degree is preferred
Experience in Medicaid Billing and OPWDD/OMH Services highly desired
At least 1-3 years of prior experience in health care complianceaudits is highly desired
Experience in OPWDD incident management is highly desired
KNOWLEDGE and SKILLS
Must have excellent organizational, time management, written and verbal communication skills;
Must demonstrate the ability to work efficiently and productively in an independent and collaborative
environment
Must be able to travel to local and regional locations for meetings and compliance tasks and activities
Must have flexibility to adjust to changes in priorities and assignments
OTHER REQUIREMENTS: N/A
Flexibility to work occasional hours outside of regular schedule for meetings or investigation activities.
Will be required to complete the NYS Justice Center training on Investigations within 30 days or the next available course, whichever is sooner.
New York State Driver’s License that meets Company requirements
WORKING CONDITIONS
Job assignments may take place indoors and outdoors, in various environmental conditions including rain, snow and cold weather.
PHYSICAL REQUIREMENTS
Job-related physical abilities an individual must possess in order to perform the job in a satisfactory manner. In some cases accommodations may be made in accordance with JM Murray policy and with our mission. | ||||
0-24 % | 25 -49 % | 50 -74 % | 75 –100 % | |
Standing/Walking/Mobility: Must be able to stand to operate equipment; mobility to embark and disembark from equipment. | X | |||
Environmental Conditions: Must be able to work in an environment that includes, but is not limited to noise, cold, heat and odors. | X | |||
External Conditions: Must be able to work in a position requiring exposure to the weather conditions. | X | |||
Lifting: Must be able to lift unaided, at least 10lbs | X | |||
Must be able to lift unaided, from 11-30lbs | X | |||
Must be able to lift unaided, from 31-70lbs | X | |||
Must be able to lift unaided, from 71-100lbs | X | |||
Must be able to lift unaided, over 100lbs | X | |||
Manipulating /Grasping/Feeling: Must be able to write, type, and use office and/or other equipment and handle materials. | X |
APPLICANTS
I have reviewed this job description and I am able to perform the essential functions as outlined. I have discussed any questions I may have about this job description prior to signing this document.
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EMPLOYEE
I have reviewed this job description and I understand all of my job duties and responsibilities. I am able to perform the essential functions as outlined. I understand that my job may change on a temporary or regular basis according to the needs of my department without it being specifically included in the job description. I have discussed any questions I may have about this job description prior to signing this document.
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