Compliance & Privacy Officer
Under limited supervision, the Compliance and Privacy Officer is responsible for establishing and implementing an effective compliance Program, including fraud, waste and abuse, to prevent illegal, unethical or improper conduct consistent with applicable laws, regulatory and accreditation standards and HPSJ policies. Work is varied and complex, and requires a high degree of discretion and independent judgment.
Compliance Manager, Compliance Analyst, Internal Auditor and others as appropriate.
• Identifies, develops and implements or oversees the implementation of strategies; oversees the development of associated business plans.
• Develops and is responsible for the implementation and oversight of HPSJ’s Compliance Program, Anti-Fraud Plan and Annual Compliance Work Plan.
• Chairs the Compliance Committee and Privacy Security Operations Committee and ensures the committee meets the goals as outlined in the HPSJ Compliance Plan and Annual Compliance Work Plan; ensures all sub-committees to the Compliance Committees (when necessary) are formed and operate on a regular basis to meet their intent.
• Monitors the performance of the compliance program, including privacy and fraud, waste and abuse, and related activities on a continuing basis.
• Reviews and analyzes, or oversees the review and analysis of legislation and regulations to determine the impact on plan operations; identifies the need for new or revised policies, procedures, plan documents, etc.; makes recommendations to management; develops and implements as required.
• Develops and implements communication and educational programs and activities for internal and external stakeholders on compliance, and regulatory and contract requirements in an effective and timely manner.
• Conducts investigation of actual and potential privacy and fraud, waste and abuse violations by HPSJ employees , vendors and business associates; determines actions to mitigate violations and breaches; documents and reports to Executive Management or applicable regulators as required.
• Assists internal departments with the implementation, maintenance and update of compliance activities, including new and revised policies, procedures and corrective action plans.
• Leads the development and renewal of HPSJ’s state contracts and contract amendments.
• Develops, implements and monitors vendor, administrative, and grant agreements/contracts processes.
• Plans for and oversees annual external audits; responds to, logs and tracks deficiencies; develops and monitors corrective action plans.
• Serves as the Plan’s contact for regulatory agency inquiries and issues; ensures that communication and responses are accurate and consistent.
• Oversees the identification, preparation, maintenance and monitoring of appropriate and required data, records, reports and other documentation; includes regulatory filings.
• Oversees the reviews and responses to requests and subpoenas for protected health information.
• Develops and conducts compliance and related training programs and activities for HPSJ employees and vendors in an effective and timely manner.
• Fosters a work environment that respects the importance of the privacy of member, client and employee information.
• Promotes and maintains, and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
• Hires, develops and retains, and ensures that direct reports hire, supervise and retain a competent staff.