Job Details

Director, Regulatory Affairs, Compliance & Privacy

Company name

AllWays Health Partners

Organization Type

Public Interest

Job Type

Attorney

Date Last Verified

Oct 17,2019

Valid Through

Jan 30,2020

Posted on

Sep 30,2019

Years of Experience

5-7 yrs required

Location

Somerville, MA, United States

Employment Type

Full-time

Industry

Legal
Practice Area
Data Privacy >> Data Privacy
Government and Government Relations >> Government and Government Relations
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Director, Regulatory Affairs, Compliance & Privacy
Duties: Report directly to the SVP, Legal, Regulatory Affairs and Compliance and dotted line report to Partners Health System, Vice President for Compliance, Audit & Business Integrity. Provide supervision to the Legal, Regulatory Affairs and Compliance Department in the absence of the SVP of Legal, Regulatory Affairs and Compliance. Act as Chief Privacy Officer responsible to ensure compliance with and develop and manage policies and protocols to secure and protect health information. Work with AllWays Health Partners Security Officer. Develop and maintain productive relationships with all levels of management, staff as well as regulators, government agency personnel and other relevant parties. Work with operational leadership to provide support and information to ensure that they and their employees gain the requisite knowledge of regulatory issues and requirements and contractual obligations to carry out their responsibilities in a compliant, lawful and ethical manner. Work and communicate effectively with Partners Health System Office of General Counsel, and Compliance, Audit and Business Integrity and Privacy Departments and others as needed to support functions, projects and requirements of AllWays Health Partners and the Legal, Regulatory Affairs and Compliance Department. Maintain working relationships with regulators and others to clarify and resolve issues. Relevant agencies include Massachusetts DOI, Connector, EOHHS and federal CMS, CCIO and others. Develop, implement, monitor and update policies, procedures and practices designed to promote compliance with the requirements set forth in Federal and State Health Programs. Document, maintain and audit a coordinated legislative and regulatory compliance program including development of data to measure and inform compliance and meet the expectations of regulators, accrediting bodies and corporate financial audit standards and measures performance. Identify and assess areas of compliance risk for AllWays Health Partners. Develop and promote preventive strategies, processes and best business practices. Collaborate with the Standards, Expectations and Compliance Committees to effectively incorporate the audit and compliance program into AllWays Health Partners operations. Participate in the development, implementation and presentation of educational and training programs addressing compliance and privacy and incorporating regulatory and contractual changes affecting the Medicaid, Medicare and Commercial and other insurance products. Develop and ensure that internal controls maximize and prevent significant instances or patterns of illegal, unethical or improper activities. Support investigations with legal counsel for violations of law or policy. Conduct or oversee investigations as appropriate. Oversee and follow-up and, as applicable, implement corrective actions and other issues generated by the compliance program or regulatory activities. Coordinate filing of regulatory forms and reports. Assist in researching and informing departments of regulations to develop procedures to comply, as well as drafting responses to queries by regulatory agencies or employer groups. Responsible to conduct investigations and take action if there is a reported breach of privacy. In coordination with AllWays Health Partners Security Officer, develop and implement, mechanisms to oversee the application of privacy policies, including providing staff orientation and on-going training. Develop and implement processes to review requests for the use of PHI, including review and approval of research requests, limited data set requests, business associate agreements and requests made by plan sponsors and regulatory agencies. Develop and implement processes to detect and respond to unnecessary PHI collection and to privacy violations, including review of employee access to member records, review of information requests made by Health Partners and reporting mechanisms for privacy violations. Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect. Other duties as assigned with or without accommodation.

Qualification and Experience

Qualifications: Bachelor’s Degree or the equivalent combination of training and experience, plus 5-7 years' related experience. 7 years of management experience in a highly regulated industry, such as health insurance. JD Degree or Master’s degree preferred. Previous accreditation, state or federal regulatory or managed care compliance experience, experience using the System for Electronic Rates & Forms Filing (SERFF), certified in Healthcare Privacy Compliance (CHPC); experience with commercial health insurance and ERISA. Demonstrate Health Partners’ core brand principles of always listening, challenging conventions, and providing value. High Integrity and EQ Excellent judgment Demonstrated ability to coach and mentor staff Proven and effective leadership skills Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner. Strong influencing skills including perseverance, creativity and flexibility Bring fresh ideas forward by listening to and working with employees and the people we serve. Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence various targeted audiences Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Excellent organizational and analytical skills. Accountable for delivering high quality work. Ability to work well both independently and as a key team member. Ability to effectively present information and respond to inquiries from employees, senior management, regulatory agencies and business associates. Ability to manage multiple projects, meet deadlines and adjust to changes in company policies, procedures and priorities. Ability to read, analyze and interpret clinical research, general business periodicals, professional journals, government regulations and legal documents. Ability to write clear, concise reports, business correspondence and procedures. Proficient in internet research Proficient in Microsoft Office Products and adept at learning new platforms and functions.

Additional info

Ref. 3107581

Company info

Hiring Coordinator
AllWays Health Partners
399 Revolution Drive
Somerville, MA 02145

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