Ambulance Billing Compliance Officer
Category: Exempt
Pay Grade: E18
Job Code: 10930
To perform this job successfully, an individual must be able to perform the essential job functions satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary job functions herein described. Since every duty associated with this position may not be described herein, employees may be required to perform duties not specifically spelled out in the job description, but which may be reasonably considered to be incidental in the performing of their duties just as though they were actually written out in this job description.
JOB SUMMARY
Performs highly responsible professional, administrative, and technical work providing compliance oversight for the Ambulance Billing Department; works closely with the Department Director, Managers, Division Supervisors, and contracted vendors to ensure compliance with Department policies, procedures, and all applicable healthcare legislation, specifically as it relates to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Medicare, Medicaid, and other private health insurances billing regulations.
ESSENTIAL JOB FUNCTIONS (examples, not all inclusive)
- Develops, implements, and monitors policies and procedures that align with HIPAA, Medicare, Medicaid, and other applicable healthcare requirements;
- Monitors industry trends related to privacy laws, including but not limited to guidance and interpretative information provided by the Department of Human Services, ensuring the department’s policies and procedures reflect current guidance;
- Identifies potential HIPAA security and regulatory compliance risks and makes recommendations to mitigate risks;
- Develops mechanisms to perform internal audits and risk assessments, respond to external audits, and adhere to regulatory and departmental policies and procedures;
- Conducts periodic internal audits of activities, relevance of job functions to the level of access to Personal Health Information (PHI), and the physical and technical security of PHI;
- Participates in the department’s responses to external audits related to ambulance billing and/or HIPAA;
- Ensures that Business Associate Agreements are compliant with HIPAA and consistent with the Minimum Necessary Standards, and all other relevant departmental polices;
- Develops and implements privacy training for staff, temporary employees, volunteers, and business associates;
- Oversees the department’s response to request for access, amendments, restrictions, or accounting of PHI disclosures;
- Supervises the work activities of the compliance staff, provides technical guidance and resolution of work issues, coordinates and prioritizes work, and offers coaching, counseling, and conflict resolution;
- Serves as the designated individual to receive internal and external complaints regarding privacy practices;
- Acts as liaison with County Attorney’s Office on HIPAA and/or Ambulance Billing related issues;
- Reports audit results, compliance efforts, and any other applicable activity to the Compliance Committee on a quarterly basis;
- Performs other related job duties as assigned.
QUALIFICATIONS
Education and Experience:
Six (6) years of responsible technical, professional, and administrative functions in public administration, regulatory compliance, health services, or a related field that includes four (4) years with an entity regulated under HIPAA, Medicare, and Medicaid; or a Bachelor’s degree and three (3) years of experience as described above; or a Master’s degree and two (2) years of experience as described above; or an equivalent combination of education, training, and/or experience.
Special Qualifications (May be required depending on area of assignment):
- Florida Driver’s License or Florida Commercial Driver’s License and endorsement, if any.
- Assignment to work a variety of work schedules including compulsory work periods in special, emergency, and/or disaster situations.
- May require a college degree, occupational certifications, and specialized training directly related to the position’s requirements.
- Other knowledge, skills, abilities, and credentials required for a specific position.
Knowledge, Skills and Abilities:
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA), Medicare, Medicaid, and private health insurances;
- Skill in verbal and written communication, including the ability to communicate legal information to non-technical/legal staff, business associate, or general public;
- Skill in organization and problem-solving;
- Skill in the development of processes, procedures, and workflows;
- Ability to interpret and apply complex State, Federal, and private rules and regulations pertaining to healthcare;
- Ability to translate intent of regulations into written policies and procedures applicable to the Department’s functions and compliant with associated regulations;
- Ability to make clear, concise, and technically accurate presentations to large groups;
- Ability to demonstrate diplomacy with staff, vendors, and business associates when performing audits and providing critical feedback or information;
- Ability to lead a team effectively;
- Ability to use small office equipment, computers, and highly technical computer applications.
PHYSICAL/MENTAL DEMANDS
The work is sedentary work which requires exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly. Additionally, the following physical abilities are required:
- Feeling: Perceiving attributes of objects, such as size, shape, temperature or texture by touching with skin, particularly that of fingertips.
- Fingering: Picking, pinching, typing, or otherwise working, primarily with fingers rather than with the whole hand as in handling.
- Grasping: Applying pressure to an object with the fingers and palm.
- Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. Occurs to a considerable degree and requires substantial use of upper extremities and back muscles.
- Reaching: Extending hand(s) and arm(s) in any direction.
- Visual ability: Sufficient to effectively operate office equipment including copier, computer, etc.; and to read and write reports, correspondence, instructions, etc.
- Hearing ability: Sufficient to hold a conversation with other individuals both in person and over a telephone; and to hear recording on transcription device.
- Speaking ability: Sufficient to communicate effectively with other individuals in person and over a telephone.
- Mental acuity: Ability to make rational decisions through sound logic and deductive processes.
- Talking: Expressing or exchanging ideas by means of the spoken word including those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
- Repetitive motion: Substantial movements (motions) of the wrist, hands, and/or fingers.
- Standing: Particularly for sustained periods of time.
- Walking: Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.
WORKING CONDITIONS
Work is performed in a dynamic environment that requires sensitivity to change and responsiveness to changing goals, priorities, and needs.