Healthcare Compliance Specialist

Role Overview :

The Compliance Specialist is responsible for the development and execution Medicare and HIPAA / Privacy Compliance Programs, reinforcing a strong culture of organizational-wide Medicare compliance, privacy, HIPPA, and risk mitigation. The position oversees efforts to keep the organization in compliance with applicable rules, regulations, company policies, and best practices. This position will effectively manage Medicare, as directed by clients, audits, data / utilization reporting processes, and other similar activities. This position serves as a collaborative resource internally and externally regarding compliance, privacy, security, and risk issues.

Role Responsibilities :

• Oversee the Medicare and HIPAA Privacy Compliance Program, ensuring that company remains up to date on and in compliance with applicable rules and regulations, and best practices including :
• Development and implementation of Medicare and HIPAA / Privacy compliance policies, procedure and practices for company and its related activities (operations) to ensure business is conducted in an ethical, appropriate, and legal manner.
• Serves as the key point of contact, internally and externally, for Medicare and HIPAA / Privacy regulatory and compliance matters.
• Routinely reviews the Compliance Program in assessing adherence to expectations and emerging regulatory requirements.
• Provides Bi-Monthly Reports to be included in Board Report packets on the Medicare Compliance Program.
• Effectively manage, as directed by clients, Medicare audits, reporting requirements processes, and other similar activities. This includes Medicare Part C ODR reporting and data validation audit processes. Must meet all timelines and achieve a high degree of accuracy and efficiency.
• Effectively and appropriately handle Medicare communications and meetings with clients.
• Responsible for the organization’s HIPAA / Privacy Program including but not limited to daily operations of the program, development, implementation, and maintenance of policies and procedures, training new and existing employees on these policies / procedures, monitoring program compliance, investigation and tracking of incidents and breaches and insuring patients’ rights in compliance with federal and state laws.
• Works with senior management and Compliance Committee to establish governance for the privacy program.
• Collaborate with Security Officer to ensure alignment between security and privacy programs.
• Performs required breach risk assessment, documentation, and mitigation. Works with Human Resources to ensure consistent application of sanctions for privacy violations.
• Serves as the internal subject matter expert on HIPAA / Privacy, maintaining current knowledge of HIPAA laws and regulations, and any other applicable federal and state privacy laws or regulations.
• Investigation of Compliance Issues
• Leads inquiries into alleged violations of rules, regulations, policies, & Codes of Conduct by evaluating and recommending investigations as appropriate.
• Ensure channels of communication regarding compliance issues are monitored and routed appropriately.
• Develops, reviews, and updates internal Medicare and HIPAA / Privacy compliance procedures, tools, and resources. Monitors the day-to-day activities to ensure compliance across the company.
• Corrective Action Plans :
• Work with Compliance Officer in developing corrective action plans for the resolution of problematic issues or to address areas of compliance vulnerability.
• Serves as a key liaison for the executive team and CEO for company’s Enterprise Risk Management (ERM) Program including disaster recovery and business continuity plans.
• Ensures proper reporting of violations or potential violations to CEO and Compliance Officer.
• Policies & Procedures :
• Ensure organizational Medicare and HIPAA / Privacy policies and procedures comply with federal, state, and client requirements.
• Responsible for monitoring rules and regulations as applicable to ensure organizational compliance. Revise and update Policies and Procedures as needed to ensure compliance.
• Adhere to applicable regulatory reporting guidelines and filing deadlines.

Other Functions

Minimum Qualifications and Experience