Quality- HIPAA/Compliance

MedExpert Billing; Chennai District; Hybrid; INR 500,000 - 700,000; Full time

Job summary

MedExpert Billing is seeking a Quality-Compliance/HIPAA Specialist to execute incident reporting, breach assessments, and defensible documentation. You will bridge compliance and operations, monitor alerts, perform risk assessments, and manage PHI securely within client folders.

You will coordinate with internal and global teams, respond to stakeholders via JIRA or email, and contribute to policy updates and training based on trend analysis.

Qualifications

• Bachelor’s degree in healthcare, business, or related field or equivalent experience.
• 1–3 years of direct experience in healthcare compliance and reimbursements.
• Strong knowledge of healthcare compliance and payor rules.
• Analytical, problem-solving and communication skills.
• Ability to develop educational materials and train others.

Responsibilities

• Monitor inbound alerts via the Incident Reporting Inbox and Jira queue.
• Complete initial review and assignment within 48 hours of submission.
• Conduct root-cause investigations of billing histories and incidents.
• Populate HIPAA Breach Risk Assessments using the template.
• Maintain client folders with securely stored PHI.
• Log action items and track incident closure.
• Notify stakeholders with context while preserving anonymity.
• Identify trends to inform policy and training updates.

Skills

Healthcare compliance

Billing knowledge

Analytical skills

Communication skills

MS Word/MS Excel

Education

Bachelor's degree or equivalent

Tools

Jira

Job description

The Quality- Compliance/HIPAA is responsible for executing the HIPAA Incident Reporting Process to ensure all data privacy events are promptly identified, thoroughly investigated, and effectively mitigated. This role acts as a critical bridge between compliance and operational teams, executing robust HIPAA Breach Assessments to determine if a formal breach has occurred and maintaining defensible documentation for all completed actions.

Major Responsibilities/Activities

• Monitor Inbound Alerts: Actively monitor the dedicated Incident Reporting Inbox and JIRA queue to identify newly reported potential HIPAA incidents.
• Meet Strict SLAs: Complete the initial review and assignment of all reported incidents within the first 48 hours of submission.
• Historical Analysis: Conduct comprehensive searches in Outlook and JIRA using run/encounter numbers to determine if an incident has been previously reported or requires updated documentation.
• Root Cause Investigation looking at Audit Billing Histories: Dig into patient accounts using proprietary billing platforms to reconstruct the history of a claim and understand the narrative of what occurred.
• Execute Risk Assessments: Populate and manage the HIPAA Breach Risk Assessment utilizing the Compliancy Group Template. Identifying the Issue, who was involved, what happened and how it was Resolved.
• Analyze Regulatory Exceptions: Methodically evaluate incidents against standard HIPAA Privacy Act exceptions to determine breach status.
• Maintain Client Folders: Organize, create, and save securely dated documentation and necessary snippets of Protected Health Information (PHI) within specific client directories.
• Action Item Tracking: Outline and log all corresponding tasks required to successfully close an incident out.
• Stakeholder Notification: Reply to original ticket submitters/groups via JIRA or email to acknowledge reports, outline the incident context (ensuring complete anonymity of employee names), and clarify outstanding next steps.
• Educational Feedback: Provide constructive feedback directly to leaders of internal users who caused the compliance issue to drive continuous workforce education.
• Operational Alignment: Partner with internal and global operational teams using the Client Matrix to coordinate complex account fixes like voids, unmerges, or claim reviews.
• Workflow Hygiene: Keep JIRA tickets updated with accurate statuses (e.g., In Progress, Done, or Done, Pending Void Acknowledgement) and confirm completion of associated Word documentation.
• Monitoring, Escalations, & Trend Identification
• Strategic Escalations: Spot atypical or severe compliance violations (e.g., physical records taken off-site) and immediately escalate them to the Compliance Director and Compliance Manager for advanced investigation.
• Trend Analysis: Identify and communicate compliance patterns or systemic trends to leadership to prompt initiative-taking updates to policies, procedures, and training programs.

Required Education, Skills, & Experience

• Bachelor’s degree in healthcare, Business, or related field or equivalent experience.
• 1-3 years of direct experience in healthcare compliance and reimbursements.
• Strong, demonstrated knowledge of all aspects of healthcare compliance.
• Demonstrated understanding of the medical billing cycle and payor rules and regulations.
• Strong decision-making, problem-solving, critical thinking, and analytical skills with the ability to identify the problems and determine appropriate next steps.
• Ability to assist with developing effective educational materials and train others to achieve results.
• Willing, eager, and able to learn and interpret new laws and directives as they are issued and apply to business operations.
• Strong collaboration skills with the ability to work across department lines to achieve results.
• Highly organized with the ability to manage time, prioritize work effectively, and remain productive.
• Ability to communicate and manage sensitive information in a confident manner.
• Ability to effectively meet deadlines.
• Elevated level of accuracy and diligence.
• Proficiency in Microsoft Word, Excel, Outlook, and Power Point.
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties.
• Proficiency in English is necessary for job-related communication, including understanding policies, writing correspondence, and engaging with colleagues or clients.

Preferred Education, Skills, & Experience

• Experience building and maintaining strong relationships with key internal staff and external contacts, demonstrating credibility, and representing company values in a positive manner.
• Experience participating in and/or leading industry-related conferences, trade shows, and professional-development opportunities.
• The office environment is a controlled indoor setting with minimal exposure to adverse conditions.
• Noise levels in the office are typically moderate and consistent with a standard office setting.
• For employees approved to work in a hybrid or remote setting, a quiet, private workspace free from significant distractions is required to ensure productivity during work hours.
• A reliable internet connection is required for hybrid/remote work. EMS|MC will provide necessary equipment, including a computer, monitor, keyboard, mouse, and headset.

Physical Requirements:

• Sitting: frequent and prolonged periods of sitting at a desk while working on a computer.
• Communication: frequent and prolonged periods of speaking, listening, reading, and writing.
• Fine motor skills: frequent use of hands for typing and operating a computer mouse.
• Movement: Limited due to Remote work. Frequent movement is encouraged.
• Flexibility to work extended hours to support the business as required.