Privacy Analyst, Out of Network

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:

1. 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.
2. Investigates inappropriate disclosures or privacy breaches of PHI ensuring compliance with reporting timeline guidelines.
3. Review and approve outgoing and incoming correspondence to providers ensuring complete accuracy.
4. Research systems and database for historical performance and outcomes to provide analytics.
5. Maintain reports that will improve quality and improve the management of workflow.
6. 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.
7. Responsible for compiling data and tracking of all investigated reported privacy incidents to report on a quarterly basis.
8. Responsible for the review, maintenance and updates to existing agreements in the system.
9. Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed.
10. 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.
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company’s Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data – this role is considered to be a High Risk Role.
15. 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 perip