- Manages the development, implementation and analysis of quality and risk measurement methodologies and performs audits to ensure compliance with regulatory agencies to include the preparation of patient or data lists, review of audit criteria, creation of excel spreadsheets and formulas to calculate the compliance rate; and prepares written reports of the audit. Creates and manages corrective action plans indicated by audit results. Facilitates process improvement activities. May participate in root cause analysis (RCA) activities.
- Ensures non-medical audits are completed and that controls are established to identify risk exposure in all affiliate departments, including but not limited to: cash handling, expense reimbursement, purchasing, non-clinical contract approval, Information Technology (IT), Health Insurance Portability and Accountability Act (HIPAA), facility maintenance and security, training records, contact center, and drug inventory management. Ensures the creation or revisions of PPGT policies and procedures as indicated by audit results. Completes process improvement activities as indicated.
- Monitors, maintains, revises, and creates agency policies relating to medical services such as Medical Standards and Guidelines (MSGs), Risk and Quality Management (RQM) policies, Safety and Infection Control policies, Laboratory manual and other departmental policies. Utilizes PPGT’s policy management system to create and revise policies.
- Provides oversight of data analysis of affiliate incident reports (IRs) and annual complication reports. Ensures accurate tracking of IRs. Prepares and analyzes monthly incident reports evaluating trends in incident type, location, region, and/or type of violation. Monitors reports for patterns and alerts management as appropriate. May complete external reports as required.
- Ensures compliance with regulatory agency and grantors relating to clinical services requirements including but not limited to Occupational Safety and Health Administration (OSHA), Clinical Laboratory Improvement Amendments (CLIA), Planned Parenthood Federation of America (PPFA), Elements of Performance (EOPs), Affiliate Risk Management Services (ARMS), Health Insurance Portability and Accountability Act (HIPAA), Department of State Health Services (DSHS), Health and Human Services Commission (HHSC), Title X and other funding sources.
- Designs and delivers training curriculum, course content, and materials for trainings required by regulatory agencies; responds to development requests from other departments.
- Produces timely and accurate reports upon request within PPGT or to PPFA regulatory agencies as needed.
- May process medical record requests.
- Has unrestricted access to patient protected health information (PHI) on paper and electronic forms health records for purposes of treatment, payment, and/or healthcare operations. The use of a patient’s protected health information should be limited to information needed for the specific task that is being performed or requested by the individual patient. Disclosure of any patient information must be for purposes of treatment, payment or healthcare operation OR must be accompanied by a valid patient authorization. Must adhere to minimum necessary rule.
- Other related duties as assigned.
- Duties and responsibilities may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing.
|