Regulatory Affairs Manager
Company: Partnership HealthPlan of California
Location: Fairfield
Posted on: June 19, 2022
Job Description:
Overview:Responsible for leading and managing employees in the
assigned areas of responsibility within
the Regulatory Affairs Unit. Manages and maintains relationships
with state and federal
regulators. Responsible for managing the plan's HIPAA and Fraud,
Waste, and Abuse (FWA)
program to ensure plan is within compliance. Develops reports and
present information to all
levels of PHC leadership. Oversees the day to day operations
related to the investigation, case
management and reporting of potential privacy and FWA incidents to
ensure the timely
submission of all regulatory reporting requirements are met. Also
responsible for managing the
validation and submission processes related to enterprise wide
regulatory reporting requirements.Responsibilities:
- Provides daily direction to direct reports and is responsible
for management, including timecards, performance discussions,
mentorship, and development plans.
- Assigns workload and monitors performance, evaluates priority
level and makes changes as necessary.
- Meets with direct reports to review project and program status
on a routine basis, provides feedback and guidance where
appropriate.
- Promotes team development and works with direct reports to
establish development plans.
- Coaches and mentors Regulatory Affairs Unit staff.
- Identifies, monitors and evaluates unit's operations to ensure
optimal efficiency and effectiveness.
- Manages and maintains relationship through communications with
DHCS and DMHC as one of HealthPlan's primary contacts as well as
communicates routinely with DHCS Privacy Officer, DHCS Program
Integrity Unit, DHCS Audit & Investigation Unit, California's
Department of Justice and the Office of Civil Rights.
- Develops tools and standard processes to ensure regulatory
reporting requirements and other ad hoc deliverables such as
inquires, surveys or request are submitted timely.
- Works closely with other departments on responding to
inquiries, surveys and other ad hoc requests from regulatory
agencies.
- Works collaboratively with department subject matter experts
(SME) to implement new regulatory reporting requirements or
templates and assist in troubleshooting regulatory reporting
issues.
- Responsible for managing duties that ensure the accuracy,
completeness and truthfulness of enterprise wide regulatory
reporting including data, information and documentation submitted
to regulatory agencies.
- Manages the tracking, monitoring and communication of
regulatory communications to impacted areas and Senior
Management
- Chairs meetings related to compliance including the Physical
Technical, and Administrative Safeguard Sub-Committee and Fraud,
Waste and Abuse Sub-Committee as well as those related to
regulatory requirements or regulatory reporting changes.
- Works with PHC's Privacy Officer to develop, implement and
maintain the organizations privacy policies, procedures, and
guidelines in compliance with federal and state laws.
- Acts as designee for Compliance Office and Privacy Officer to
independently investigate and act on compliance, privacy and FWA
related activities including internal investigations, hotlines
calls, or other issues reported and implementing corrective action
plans as appropriate.
- Maintains a modified caseload in the area of assignment
including escalated or sensitive cases involving employees in which
is responsible for conducting investigations including interviewing
employees, collecting and maintaining documentation, and providing
recommendations to Compliance and/or Privacy Officers as
appropriate.
- Prepares routine privacy risk assessment and presents
recommendations to PHC's Privacy Officer and other Senior
Leadership.
- Manages the tracking and trending of privacy and FWA cases to
identify systemic issues, problem providers and/or members
- Collaborates with satellite and regional offices to standardize
plan wide privacy practices.
- Develops and implements departmental goals annually designed to
increase performance and efficiency of unit.
- Develops or oversees the development of compliance trainings,
including:
- New hire compliance training and Compliance Primers,
- Annual compliance training - HIPAA, FWA, and Code of
Conduct
- Annual Compliance Plan training
- Targeted departments - as applicable on topics identified
through tracking and trending of privacy or FWA incidents as well
upon request by departments for refresher trainings or other topics
requested, and;
- Other mandatory compliance trainings
- Manages the maintenance of the Regulatory Affairs and
Compliance dashboard:
- Monthly reporting of privacy, FWA, and compliance issues
statistics.
- Reports statistics to PTAS Sub-Committee, FWA Sub-Committee and
Compliance Committee.
- Delegation Oversight responsibilities including auditing and
monitoring of compliance with privacy, FWA and other regulatory
reporting requirements.
SECONDARY DUTIES AND RESPONSIBILITIES
- Researches complex regulatory related inquires, provides
accurate and timely responses utilizing all applicable State and
Federal regulationsQualifications:Education and Experience
Bachelor's Degree in Business, Communication, Healthcare
Administration, Business Administration, or related field; a
minimum of 2-3 years of experience in the health care field,
managed care
experience preferred, with knowledge of Medi-Cal, Knox-Keene,
and
Medicare regulations; or an equivalent combination of education
and
experience. Minimum two (2) years of experience with conducting
privacy and/or fraud investigations preferred.
Special Skills, Licenses and Certifications
HCCA Certified in Healthcare Compliance (CHC) or Certified in
Healthcare Privacy Compliance (CHPC) preferred. Solid collaboration
and facilitation skills required. Valid California driver's license
and proof of current automobile insurance compliant with PHC policy
are required to operate a vehicle and travel for company
business
Performance Based Competencies
Demonstrated leadership skills/experience. Ability to work within
an
interdisciplinary structure and function independently in a
fast-paced
environment while managing multiple priorities and deadlines.
Excellent oral and written communication skills. Excellent
organizational skills required. Diplomacy and tact in handling
sensitive information regarding personnel affairs as required.
Ability to interact with executives and vendors effectively,
handling all assignments with efficiency. Excellent judgment.
Work Environment And Physical Demands
More than 50% of work time is spent using a desktop computer. When
necessary, the ability to lift, carry, or move manuals and reports,
weighing up to 25 lbs. Ability to travel as needed. Must be able to
work in a fast paced environment and maintain courtesy and
composure when dealing with internal and external customers.
Ability to function effectively with frequent interruptions and
direction from multiple team members.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan's policies and procedures, as they may
from time to time be
updated.IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions,
experience, educational factors and the requirements and conditions
listed in this job description are representative only and not
exhaustive of the tasks that an employee may be required to
perform. The employer reserves the right to revise this job
description at any time and to require employees to perform other
tasks as circumstances or conditions of its business, competitive
considerations, or work environment change.
Keywords: Partnership HealthPlan of California, Fairfield , Regulatory Affairs Manager, Executive , Fairfield, California
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