Privacy and Compliance Manager (6232U), Optometry Clinic - #74363

At the University of California, Berkeley, we are dedicated to fostering a community where everyone feels welcome and can thrive. Our culture of openness, freedom and belonging make it a special place for students, faculty and staff.

As a world-leading institution, Berkeley is known for its academic and research excellence, public mission, diverse student body, and commitment to equity and social justice. Since our founding in 1868, we have driven innovation, creating global intellectual, economic and social value.

We are looking for applicants who reflect California's diversity and want to be part of an inclusive, equity-focused community that views education as a matter of social justice. Please consider whether your values align with our Guiding Values and Principles, Principles of Community, and Strategic Plan.

At UC Berkeley, we believe that learning is a fundamental part of working, and provide space for supportive colleague communities via numerous employee resource groups (staff organizations). Our goal is for everyone on the Berkeley campus to feel supported and equipped to realize their full potential. We actively support this by providing all of our full-time staff employees with at least 80 hours (10 days) of paid time per year to engage in professional development activities. Find out more about how you can grow your career at UC Berkeley.

At the Wertheim School of Optometry & Vision Science, as part of a world-renowned university that embraces excellence and access, we foster an environment of trust and mutual respect, free expression and inquiry, and personal resilience and achievement. We demonstrate sensitivity and understanding of the diverse academic, socioeconomic, cultural, disability, gender identity, sexual orientation, and ethnic backgrounds present in our community. These principles serve us daily in our reasoning and actions and aid us in our decision making.

We educate an estimated 320 students annually. Our O.D. program is a 4 year program with clinical training provided at 2 campus clinics, 10 satellite clinics (community care), 7 VA clinics, and 24 external clinics across the country. Our one-year post-graduate residency programs provide advanced clinical education in specialty areas of optometry with placement on and off campus and our Vision Science program averages 40 PhD students.

The Optometry Clinic provides comprehensive optical care services to the entire Campus population and the general Bay Area community, with approximately 80,000 annual visits to Optometry Clinics at Minor Hall and the Tang Center. The Optometry Clinic is open 7 days per week and approximately 358 days per year.

The First Review Date for this job is: 12/4/2024

Compliance and Privacy Oversight

• Maintain all regulatory standards including Joint Commission, HIPAA, California Department of Public Health (CDPH), Family Educational Rights and Privacy Act (FERPA), and California's Child Abuse and Neglect Reporting Act (CANRA).
• Maintain and update all HIPAA and FERPA compliance policies and procedures.
• Create and maintain all training and educational material as regulations change.
• Provide management oversight of compliance systems and processes that protect assets from financial loss and ensure compliance with established requirements at the state and federal levels.
• Participate in Joint Commission compliance activities such as Joint Commission on Accreditation of Healthcare Organizations accreditation processes.
• Maintain current knowledge of applicable federal and state privacy laws Oversee the development and implementation of UC Optometry Clinic policies and compliance therewith and procedures for carrying out the requirements of the University's system-wide HIPAA standards and implementation Policies and the education of UC Optometry Clinic workforce with respect to the federal Privacy Rule Review documents prior to the release of personal health information in response to requests from Risk Management, External Auditors, Recovery Audit Contractors, Subpoenas, or other third parties, etc.
• Establish the institution of a regular audit of access to and use of Personal Health Information (PHI) to ensure the Minimum Necessary Rule is being upheld.
• Provide input into non-technical portions of contract proposals for insurance vendor contracts.
• Maintain Business Associate Agreements (BAAs) ensuring they are current and in compliance with federal, state, and university regulations, rules, and policies.
• Act as member and secretary to Optometry's HIPAA Steering Committee.
• Evaluate the organization's existing policies and procedures for HIPAA compliance by performing HIPAA risk assessments.
• Develop and assist with the implementation of new and updated policies and procedures.
• Maintain policies and procedures related to PHI access and use; ensures strict by all staff with access to PHI.
• Assess methods and procedures used to store and transmit PHI; identifies security or other compliance risks and research and recommend improvements.
• Maintain required records and supporting documentation including authorization forms, notices, and plan documents.
• Communicate with individuals regarding their right to inspect, amend, and restrict access to their PHI.
• Draft and implement procedures for addressing and resolving complaints regarding the organization's privacy policies and procedures.
• Serve as the internal subject matter expert on HIPAA, maintaining current knowledge of HIPAA laws and regulations, and any other applicable federal and state privacy laws or regulations.
• Report on changes in applicable laws and regulations and provides training as needed.
• Build and manage a strategic and comprehensive privacy program that defines, develops, maintains, and implements policies and processes that enable consistent, effective privacy practices which minimize risk and ensure the confidentiality of protected health information (PHI), paper and/or electronic, across all media types.
• Ensure privacy forms, policies, standards, and procedures are up-to-date.
• Work with organization senior management, security, and corporate compliance officers to establish governance for the privacy program.
• Establish, with the information security officer, an ongoing process to track, investigate and report inappropriate access and disclosure of protected healthcare information.
• Monitor patterns of inappropriate access and/or disclosure of protected health information.

Credentialing

• Maintain and update our credentialed providers, including our Residents.
• Manage and maintain insurance logins including updates to our profile information such as contact information.
• In partnership with IT, ensure our systems are updated with the most accurate information, including fee and provider information.

Health Information Management Oversight

• Responsible for the acquisition, analysis, storage, retrieval, and release of medical and related information.
• Responsible for an in-depth working knowledge of clinic systems such as Eyecare Advantage for Compulink, including upgrade needs assessments, accessibility, and limitations.
• Responsible for onboarding and training faculty, staff, and students on the use of our internal systems and policies and procedures.
• Facilitates the flow of patient health information throughout the school's eye clinics, working with directors and managers to identify information needs and establish processes for the efficient transfer of information.
• Manage Medical Records Requests
  • Manage operations of the medical records requests, including transitioning to electronic medical records, maintenance, and retention.
  • Ensure efficient operation through active management of workflow.
  • Orient new clinical staff to the medical records and electronic medical record procedures.
  • Manage electronic medical record changes and updates which may require redefining the workflow of the unit, re-training of staff, and defining security permissions in our clinic systems.
• Manage the Release of Information Requests
  • Ensure that release of information is performed in accordance with federal and state laws and University policies.
  • Review any complex or non-standard subpoenas, court orders, or other requests received by the Release of Information Specialist.
  • Maintain knowledge of applicable regulations through continuing education.
  • Develop policies and procedures in accordance with legal requirements for the release of information.
  • Serve as consultant to clinical staff and administrators concerning the use and disclosure of protected health information.
  • Oversee all scan and imaging operations to ensure that the integrity of the Electronic Medical Record is maintained and documentation is easily retrieved for review or released.
  • Manage medical record workflow, hold regular staff meetings to discuss ongoing changes, and update employees on departmental policies, procedures, and process improvement.
  • Oversee activities of contractors and short-term interns to ensure contract compliance.

Audits Claims Billing Function

• Develop and implements a billing compliance program.
• Responsible for the development and documentation of billing audit procedures
• Work closely with IT and billing departments along with clinic management to ensure billing policies and process meet current Federal, State, and University guidelines and procedures.
• Audit Claims for accuracy and timely submission.
• Assist in the development of communication tools for the anticipated upcoming changes to medical coding, clinical documentation, and electronic charge capture.
• Assume responsibility for additional anticipated needs with respect to supplies, training, scheduling, and data collection for the roll-out of the project as needed.

Assist with Patient Communications

• Review and respond to patient customer service e-mails, and phone calls and distribute and respond to complaints, compliments, etc as appropriate.
• Other duties as assigned.

• Thorough knowledge of ethics and compliance profession, theories and systems of internal control, and professional compliance and investigations standards.
• Broad knowledge of and/or ability to learn University ethics and compliance policies, procedures, and programs.
• Applies thorough ethics and compliance concepts and applications in the completion of assignments.
• Skills in problem-solving.
• Ability to gather, organize, complete analysis, and develop recommendations in the completion of assignments.
• Strong interpersonal skills and ability to collaborate effectively with diverse groups.
• Skills in coalescing viewpoints and facilitating outcomes in group settings.
• Ability to present information in a clear and concise manner both in writing and verbally.

Education/Training:

• Bachelor's degree in related area and/or equivalent experience/training.

This is a 100% full-time (40 hrs a week) exempt career position, which is paid monthly and eligible for full UC Benefits.

For information on the comprehensive benefits package offered by the University, please visit the University of California's Compensation & Benefits website.

Under California law, the University of California, Berkeley is required to provide a reasonable estimate of the compensation range for this role and should not offer a salary outside of the range posted in this job announcement. This range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to experience, skills, knowledge, abilities, education, licensure and certifications, analysis of internal equity, and other business and organizational needs. It is not typical for an individual to be offered a salary at or near the top of the range for a position. Salary offers are determined based on final candidate qualifications and experience.

The budgeted salary range that the University reasonably expects to pay for this position is $93,000.00 - $122,000.00.

To apply, please submit your resume and cover letter.

• This is a 100% full-time (40 hours per week), career position that is eligible for full UC benefits.
• This position is exempt and paid monthly.
• This is a hybrid position, eligible for 20% remote capability.

This is a designated position requiring fingerprinting and a background check due to the nature of the job responsibilities. Berkeley does hire people with conviction histories and reviews information received in the context of the job responsibilities. The University reserves the right to make employment contingent upon successful completion of the background check.

Employment is contingent upon passing a physical exam.

The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information about your rights as an applicant, please see the U.S. Equal Employment Opportunity Commission poster.

For the complete University of California nondiscrimination and affirmative action policy, please see the University of California Discrimination, Harassment, and Affirmative Action in the Workplace policy.