Contact Jane Graham at 203-899-1770 x8000 or via email at firstname.lastname@example.org
Open Position(s): 3
- Director, Human Resources, Risk Management & Compliance
- Director, Quality Development and Improvement
- Medical Billing Specialist
Job Title: DIRECTOR,
HUMAN RESOURCES, RISK MANAGEMENT & COMPLIANCE
Reports To: Chief
FLSA Status: Exempt
Approved Date: 10/9/2014
Guide and manage the overall provision of human resources services,
policies, and programs. Oversee the compliance program as an independent and
objective reviewer. Examines, evaluates,
and investigates organizational risk. Assures the behavior in the organization
meets company’s policies and Standards of Conduct. Develops and/or revises
policies and programs as needed to assure such compliance.
Human Resources (60%)
- Create and manage strategic recruitment,
selection, and retention plan
- Create and management strategic training and
organizational development plan to meet personal, professional, and
organizational needs of associates
- Development and manage wage and compensation
- Monitor associate benefit plans for effectiveness
and cost containment
- Recommend and establish human resources company
policies and procedures
- Identify legal requirements and government
reporting regulations affecting human resources function (OSHA, EEO, HIPAA,
Wage/Hour, Health/Safety, Worker Compensation, and FMLA)
- Develop and Implement new associate orientation
- Direct the preparation of information requested
or required for compliance
- Acts as primary contact with labor counsel and
outside government agencies
- Direct a process of organizational planning that
evaluates structure, job design, and manpower forecasting throughout the
- Coordinate credentialing process for licensed
- Monitor and respond to associate concerns
- Serve as advisor to organization leaders
regarding matters of associate performance and discipline issues
Risk Management (20%)
- Develop and implement organization-wide risk
management program to identify and minimizing risk
- Develop guidelines, recommendations, and
implements process improvements to address high areas of vulnerability within
- Conducts reviews of policies and procedures to
ensure compliance with risk mitigation procedures
- Develop, implement, and monitor incident
tracking policies and procedures
- Serve as primary point of contact for risk
- Monitors compliance with federal, state, and
local guidelines (i.e. OSHA)
- Develops and implements training associate
training programs for risk management topics
- Serve as liaison between patients, medical staff
and visitors to ensure the best customer service experience
- Respond to and resolve patient complaints
- Implement and maintain comprehensive,
organization-wide corporate compliance programs
- Establish and implement an enterprise-wide
compliance audit and reporting plan, including controls and measurements, to
assure regular and ongoing monitoring and compliance
- Coordinate/conduct investigations to identify,
clarify and resolve potential compliance issues
- Provide corporate compliance training for all
new employees upon hire and annual corporate compliance training updates for
- Report compliance activities and outcomes to
executive leadership. Recommend action to improve the overall compliance
- Coordinate and maintain reporting channels
(e.g., Hotline) for use without fear of retaliation
- Maintain an up-to-date working knowledge of
relevant corporate compliance issues, laws and regulations and serve as
internal consultant to organization on same
- Bachelor’s degree in human resources management,
business administration or other closely related discipline required
- Master’s degree and PHR preferred
- Six (6) plus years’ experience gained through increasing
responsible management position in human resources management
- Healthcare, compliance, and risk management
Job Title: DIRECTOR, QUALITY DEVELOPMENT & IMPROVEMENT
Chief Medical Officer (primary)
Chief Executive Officer
Doug Olson, MD
Responsible for identifying, implementing, monitoring, and evaluating clinical quality and system wide process improvement. Collects and analyzes data and assists with performance audits to identify improvement opportunities. Recommends action plans to address quality concerns.
- Leads the continuous process improvement efforts utilizing the appropriate process improvement model Coordinates and provide support for process improvement activities.
- Coordinates PDSA cycle efforts for the organization including collecting and analyzing data, summarizing results and presenting significant findings to Performance Improvement Committee.
- Consults and reports to practitioners, administration and the Performance Improvement Committee on quality, performance improvement, and planned care model activities and goals.
- Coordinates and tracks chart audits to review clinical activities and documentation of all clinic staff
- Analyzes data collected through patient satisfaction surveys to identify areas of concern and provides recommendations for improvement to appropriate clinic management and staff. Presents significant findings, action plans, and results to Performance Improvement Committee.
- Works with CMO and COO to monitor clinic activity related to quality assurance and address concerns.
- Develops and facilitates training related to quality, the planned care model, and process and performance improvement for employees as necessary.
- Develops and implements policies and procedures related to quality improvement.
- Presents to staff and at national meetings about care model progress and changes as requested.
- Acts as to external community, including attending meetings, conference calls, etc. to maintain awareness of current issues and educates staff and administration.
- Attends meetings including designated Board meetings, management, collaborative, and performance improvement meetings; attends external meetings, groups or events as appropriate to the scope of the position and/or as assigned by management.
- Coordinate Patient Centered Medical process improvements with clinical and operations staff.
- Performs other duties as assigned.
- Registered Nurse (RN). BSN or MSN preferred.
- Experience with quality improvement methodologies (i.e. Lean, six Sigma).
- Ability to complete projects on time with minimal supervision.
- Effective verbal and written communication skills. Ability to effectively present to large groups.
- Ability to establish and maintain effective working relationships with clinical and administrative personnel.
- Proficiency with Microsoft Word & Excel; basic knowledge of Access & PowerPoint or similar applications.
- Ability to produce, interpret, and monitor data for decision-making.
Job Title: MEDICAL BILLING SPECIALIST
Medical Billing Specialist is responsible for handling all types of insurance claims, including private, Medicare and Medicaid. They are responsible for both patient and insurance collections and making sure claims are processed in a timely manner so that the organization gets properly reimbursed for services provided. This includes working on follow-ups, denials and refunds.
- Patient demographics and insurance verifications are confirmed
- Charge entry: All visits are checked for retrievable/appropriate ICD-9 and CPT codes, according to insurance guidelines.
- Approved visits are batched and sent electronically to the insurance company via clearinghouse. Paper claims might be processed for secondary insurances.
- Insurance Electronic Claim Submission and Response Reports are processed at least twice weekly.
- Insurance Denials, follow-ups, EDI file rejections, adjustments and aging
- Insurance Check postings
- Unapplied Credit/Refund requests for both patient and insurances
- Collections/bad debt for both patients/insurances
- Assist patients with billing questions, payments, etc. as needed via phone or in person
- Call insurance companies as needed to check on claims and patient eligibility
- Notify manager of any unresolved issues on real-time
- Help manager with assignments as needed
- Assist with coverage at Front Reception and Call Center as needed.
- Minimum of high school graduate or equivalent required
- At least 5 years of medical office experience in a FQHC setting.
- CPT/ICD-9 coding and insurance verification required
- Knowledge of Medicare and Medicaid FQHC billing a plus
- Insurance/Patient Collections required
- Excellent customer service skills (internal and external) is a must.
- Knowledge of Centricity preferred
- Must be detail-oriented
- Must be able to prioritize tasks
- Must be able to meet monthly deadlines
- Must be able to work in a team setting.