Clinical Operations Specialist

The Clinical Operations Specialist plays a pivotal role in ensuring the organization maintains high standards of compliance and quality within its clinical operations. This specialist conducts various types of audits, provides expert advice, performs administrative duties, engages in self-audit activities, participates in training, and attends relevant meetings.

Key Responsibilities:

• Conducting regular audits to ensure compliance with laws, regulations, and industry standards.
• Auditing files, clinicians, and conducting remediation checks to identify areas for improvement.
• Performing targeted claims checks on a monthly basis to prevent non-compliance.
• Preparing for and conducting self-audit activities to promote continuous learning and improvement.
• Engaging in clinical and professional development, including training sessions to enhance staff skills.
• Attending meetings with field and management staff, external stakeholders, and participating in clinical compliance huddles to foster collaboration.
• Consulting with the compliance team and attending meetings to ensure alignment with organizational goals.
• Responding to inquiries from the field, management, and back office to provide timely support.
• Liaising and engaging with healthcare services providers, including responding to challenges and conducting audits to ensure compliance.
• Updating procedures and policies, and preparing resources for the field to facilitate efficient operations.
• Setting up the audit plan for the year and supporting professional registration to maintain accreditation requirements.
• Developing and implementing compliance programs addressing key areas such as billing, coding, patient privacy, and fraud prevention to mitigate risks.
• Investigating compliance issues, identifying root causes, and recommending corrective actions to address recurring non-compliance.
• Developing and implementing disciplinary action plans to address recurring compliance issues.
• Monitoring and enforcing compliance with all applicable laws, regulations, and internal policies through audits, investigations, and corrective actions.
• Developing and maintaining clinical quality systems consistently across the organization to ensure seamless operations.
• Overseeing national clinical policies and procedures within the document control process to ensure accuracy.
• Creating and implementing strategies for managing clinical risks and enhancing care quality to improve patient outcomes.
• Supporting and mentoring staff on quality improvement tools and methods, and providing training to ensure all employees understand their compliance obligations.
• Monitoring HR processes and validating compliance with accreditation requirements to maintain organizational reputation.
• Reporting on quality system performance, ensuring alignment with standards and stakeholder needs to drive continuous improvement.
• Coordinating compliance efforts with other departments to ensure integration of compliance requirements into all aspects of the business.

Skills Required:

• Strong understanding of relevant laws, regulations, and industry standards.
• Experience in developing and implementing compliance programs.
• Excellent investigative and problem-solving skills.
• Ability to develop and implement corrective action plans.
• Strong communication and training skills.
• Experience in monitoring and enforcing compliance through audits and investigations.
• Ability to develop and maintain clinical quality systems.
• Strong organizational and coordination skills.

What's in it for you?

• Competitive remuneration with performance bonus.
• Yearly flu vaccinations.
• Training opportunities and career development.
• Employee Assistance Program.
• Free access to hearing aids and discounts on private health insurance.
• International career opportunities.

Empowering Excellence

Amplifying careers by helping our people achieve their full potential. Providing constant constructive feedback and training opportunities that empower our people to excel.

As an employer that embraces Equal Opportunity and promotes inclusion and diversity, we encourage people of all ages and backgrounds to apply.