At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders — internal and external – driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB SUMMARY:
This position investigates and analyzes potential breaches, privacy incidents, inadvertent disclosures, and manages and compiles documentation which occur in the Out of Network Department. This position also provides education and training to the Out of Network team members to promote and ensure compliance with relevant privacy regulations. This position is responsible for ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other federal, state, or other relevant international privacy regulations.
JOB ROLES AND RESPONSIBILITIES:
- Investigates and evaluates reported privacy incidents which occur in the Out of Network Department (OON) to determine if they are an inadvertent disclosure, if the incident(s) constitute a reportable breach.
- Investigates inappropriate disclosures or privacy breaches of PHI ensuring compliance with reporting timeline guidelines.
- Review and approve outgoing and incoming correspondence to providers ensuring complete accuracy.
- Research systems and database for historical performance and outcomes to provide analytics.
- Maintain reports that will improve quality and improve the management of workflow.
- Reports all incidents to Legal Analyst, Privacy for determination of whether an incident requires notification to clients or other regulatory bodies, such as HHS Office for Civil Rights.
- Responsible for compiling data and tracking of all investigated reported privacy incidents to report on a quarterly basis.
- Responsible for the review, maintenance and updates to existing agreements in the system.
- Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed.
- Recommend system and operation changes to improve efficiency of workflow, quality, and mitigate risk of future inappropriate disclosures or privacy breaches within the OON Department.
- Collaborate, coordinate, and communicate across disciplines and departments.
- Ensure compliance with HIPAA regulations and requirements.
- Demonstrate Company’s Core Competencies and values held within.
- Please note due to the exposure of PHI sensitive data – this role is considered to be a High Risk Role.
- The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
Individual works under general supervision to complete job responsibilities in applying knowledge of the department processes, knowledge of HIPAA, state or other relevant international privacy regulations. Work involves applying advanced skills and analysis using systems and tools for the position or specialization. Duties and tasks are standardized and the individual resolves routine questions and issues while referring more complex issues to higher levels for resolution.
Qualifications
JOB REQUIREMENTS (Education, Experience, and Training):
- High School Diploma or GED required. Associates Degree preferred.
- Minimum 2 years of experience in privacy, compliance, in a healthcare setting such as negotiations, claim processing, medical coding, provider billing, customer service, worker’s compensation or collection agency.
- Knowledge and understanding of negotiation process.
- Communication (written, verbal and listening), analytical, organizational, prioritization, technical, etiquette, and interpersonal skills
- Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites with preferred proficiency with Word, Excel, and other database software.
- Ability to be flexible in quickly shifting priorities and keeping up with changes across multiple tasks in a fast-paced environment while maintaining a positive and cooperative demeanor.
- Ability to demonstrate strong technical skills.
- Ability to identify issues and escalate for course of action for resolution.
- Ability to elicit trust and credibility with all levels of the organization.
- Ability to adjust/alter schedule to meet deadlines.
- Ability to work independently and handle confidential information.
- Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.
The salary range for this position is $45k-$55k . Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity. BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
* Medical (PPO & HDHP), dental and vision coverage
* Pre-tax Savings Account (FSA & HSA)
* Life & Disability Insurance
* Paid Parental Leave
* 401(k) company match
* Employee Stock Purchase Plan
* Generous Paid Time Off — accrued based on years of service
o WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
* 10 paid company holidays
* Tuition reimbursement
* Employee Assistance Program
* Sick time benefits — for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here. APPLICATION DEADLINE
We will generally accept applications for at least 5 business days from the posting date or as long as the job remains posted. #LI-AN1
