ERM SPECIALIST at Aultman Health Foundation – CANTON, Ohio

PURPOSE OF POSITION:

The primary purpose of the ERM Specialist is to to track, monitor, and oversee legal administrative processes. These duties will include reviewing, entering, and tracking Health Insurance Portability and Accountability Act (HIPAA) and Power of Attorney (POA) requests related to personal representative designation and private health information (PHI) requests. Additional functions include reviewing and tracking current and prospective first tier, downstream, and related entity (FDR) vendor contracts and letters of agreement (LOAs) to ensure all appropriate regulatory and compliance standards are addressed in the contract documentation, as well as monitoring the current and prospective contract entities to ensure they are not excluded from participation in Federal Health Care Programs. This will be accomplished by working closely with the Enterprise Risk Management Coordinator and keeping him/her apprised of any trends or concerns.

The role outlined below has direct reportable measures to the Centers of Medicare and Medicaid Services (CMS). These measures are tied to the Medicare Advantage contract and PrimeTime Health Plan (PTHP) Star Rating. The ERM Specialist is required to promote the timeliness and effectuation of contract reviews and HIPAA authorization review decisions that meet the standards set by CMS.

RESPONSIBILITIES & EXPECTATIONS:

· Provides support to the ERM Coordinator.

· Facilitates the vendor/contractor onboarding process

· Acts as main contact with operational areas in regards to any HIPAA authorization reviews, PHI requests, or contract reviews.

· Enters and tracks HIPAA Authorizations and POA requests.

· Maintains data tracking files and reports monthly volume of PHI requests processed to the Privacy Officer.

· Conducts and tracks initial and monthly Ohio Inspector General/General Service Administration (OIG/GSA) checks for Vendors, Temporary Employees, Contractors, and Employees.

· Conducts monthly monitoring checks of contract Providers against the Med Excluded Database.

· Maintains data tracking files on all current executed contracts and supporting documentation; including copies of all executed contracts, monthly OIG/GSA sanction screening results, annual SSAE16 reports, renewal dates, etc.

· Tracks and monitors executed Business Associate Agreements (BAA) and works closely with the Finance Department to reconcile utilization.

· Understands statutory and plan language restrictions, timelines, etc. that affect processing of HIPAA / PHI requests and contract execution.

· Responsible for all QHP, CMS, and NCQA requirements as they pertain to the contracting processes.

· Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.

· Seeks supervisory guidance/approval as appropriate.

· Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.

· Promotes and demonstrates professional standards to enhance the development of the department.

· Practices ethical conduct.

· Meets acceptable attendance and punctuality expectations (excluding FMLA)

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

QUALIFICATIONS:

· Education: High School Graduate; some college preferred and/or equivalent experience in managed care or health care field.

· Experience: Good keyboard skills, Computer experience in a windows operating system, experience with Microsoft Word, Outlook and Excel applications.

WORKING CONDITIONS:

· Office environment with moderate noise level.

· Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.

· Occasionally walking, standing, twisting/turning and reaching upward or forward during work day.