Senior Legal And Compliance Generalist

Job Purpose:

This position is responsible for overseeing the release of all medical record requests in a timely and efficient manner, while safeguarding the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information. The Senior Legal & Compliance Generalist actively audits charts for billing accuracy and directly supervises the Legal & Compliance Generalist.

Duties and Responsibilities:

• Releases medical records information to persons or agencies according to State and Federal regulations.
• Consistent application of medical privacy regulations to guard against unauthorized disclosure.
• Inspect and audit medical records for coding errors or inconsistencies, training providers and employees as necessary.
• Assists with the defense of small claims cases filed by and against the company.
• Review and respond to Insurance Carrier Audits, following up as necessary for completeness of medical record.
• Supports the Chief Compliance Officer and Compliance Committee by developing, maintaining and revising policies and procedures as well as other Compliance documents to promote adherence to related laws and regulations.
• Investigate and analyze privacy issues and report risks, develop and implement corrective action plans for resolution of problematic issues, and report risks and violations to the Chief Compliance Officer and Compliance Committee.
• Maintain HIPAA Breach log.
• Help create and revise training manuals, multimedia visual aids, and other educational materials.
• Retrieve patient information as directed.
• Communicate problems or irregularities accordingly to management.
• Other duties as assigned.

Knowledge, Skills and Abilities:

• Possess and maintain comprehensive knowledge of relevant regulatory federal, state and local laws, rules and regulations impacting health care, primarily HIPAA.
• Exhibit exemplary oral and written communication skills.
• Detail-oriented with excellent organizational skills and the ability to prioritize and work under pressure.
• Facilitate relationships with health plan partners, to develop innovative efficient processes to meet the needs of the organization.
• Coordinate quality and service initiatives, consistent with the organization's strategic plan and service lines.
• Ability to handle sensitive information and maintain confidentiality.
• Ability to model and foster ethical behavior.
• Strong customer service skills.
• Ability to work in a fast-paced environment.
• Ability to work with a sense of urgency and meet deadlines.
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
• A certain degree of flexibility and creativity are required for this position.
• Knowledge of Coast Dental policies and procedures.
• At least five years previous experience in the dental, healthcare or risk management industries required.