Job Description

Overview

The Legal & Compliance Generalist supports the Legal Department in the management and resolution of patient grievances and complaints and coordinates with the Compliance Department as appropriate. The position interacts directly with patients, Office Managers, District Managers, Government Agencies, Insurance Representatives, and internal departments to investigate and respond to patient concerns involving treatment, billing, records, and other complaints. The position coordinates appropriate responses and resolutions and identifies matters requiring escalation to the General Counsel or coordination with Compliance, Operations, clinical personnel, or other appropriate departments. This position reports to the General Counsel.

Essential Duties and Responsibilities

• Be the primary responder for the grievance distribution email; logging all emails accordingly and retrieving all necessary documents directly.
• Provides backup support for processing patient medical record requests within 30 days from receipt and maintaining corresponding log.
• Assist Insurance Grievances with resubmitting claims as needed.
• Audit patient records, investigate allegations raised by patients, and prepare responses to grievances/complaints as needed. Escalate matters involving the quality or necessity of treatment or other clinical issues to the appropriate clinical or operational personnel, and escalate matters presenting potential legal exposure to the General Counsel.
• Create and monitor refund and adjustment requests arising from patient complaints to ensure timely processing.
• Research and respond to Better Business Bureau and FDACS Complaints.
• Research and defend against all credit card disputes.
• Be a resource for the offices in regard to patient complaints and balances.
• Specific projects and tasks as assigned by the General Counsel.
• All other duties and responsibilities as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills and Abilities

• Prior experience in a dental office, healthcare, patient grievance, legal, compliance, or related environment preferred.
• Effective problem solving and analytical skills: ability to take an analytical approach to complex problems, synthesizing diverse information.
• General understanding of insurance claims and submissions.
• Skilled writer.
• Maintain strict confidentiality with sensitive patient information.
• Able to work independently, while reporting on progress to direct supervisor(s).
• Ability to handle sensitive information and maintain strict confidentiality.
• Proficient in oral communications, always demonstrating professionalism and taking accountability for actions.
• Collaboration amongst team members.

Qualifications (Experience, Education, Licensure, Certification)

• A good comprehension of Microsoft Windows computing knowledge, including track changes.
• Strong organizational skills and attention to detail.

To perform this job successfully, an individual must possess proficient knowledge of: internet software, spreadsheet manipulation via Microsoft Excel, word processing software via Microsoft Word, Outlook, and PowerPoint.

WORKING CONDITIONS

The Legal and Compliance Generalist will work in areas that are highly visible and will be provided with comfortable office space to perform the assigned duties. Workstations are clean (floor cleanliness maintained by janitorial staff – desk workspace maintained by the employee), well lighted, and relatively quiet. Work is primarily sedentary in nature.

WORKING CONDITIONS

X

INSIDE: Spends approximately 100% of time inside. Inside work area has good ventilation, comfortable temperature.

WORK POSITIONS (defined in 10% increments of work time)

80%

Stationary

10%

Standing, lifting and/or bending

10%

Move, traverse

LIMITATIONS AND DISCLAIMER

The above job description is meant to describe the general nature and level of work being performed, but is not limited to these duties; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

ACKNOWLEDGEMENT

By my signature below, I acknowledge that I have read and understand this job description with its limitations and disclaimer. I have had the opportunity to ask questions and have had them answered to my satisfaction.

LEGAL NAME (please print):

SIGNATURE: __________________________________________________________

DATE: