Sr. Director, Compliance & Privacy

Job Details

Description

Position: Sr. Director, Compliance & Privacy Officer

The Sr. Director, Compliance & Privacy Officer is an experienced compliance professional that plays an integral role in the effectiveness of Monogram Health’s Compliance Program. This individual applies their compliance, regulatory, clinical, and business acumen to ensure compliance with federal and state laws, regulations, and other applicable requirements (including, but not limited to Medicare and Medicaid rules and regulations).

Roles And Responsibilities

• Implements, administers, and oversees various aspects of the Compliance Program to promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks.
• Monitors the performance of the Compliance Program and related activities on an ongoing basis and takes appropriate steps to improve its effectiveness.
• Develops, coordinates, and participates in an effective compliance training program for new and existing employees and as required for non-employees (e.g., Board Members, Downstream Entities).
• Provides strategic compliance guidance to organizational areas with respect to laws, regulations and other applicable requirements.
• In consultation with the Chief Compliance Officer and General Counsel, investigates and acts on matters related to compliance, including the flexibility to design and coordinate internal investigations and any resulting corrective action, working with the Human Resources as appropriate.
• In consultation with the Chief Compliance Officer and General Counsel, ensures the proper reporting of violations or potential violations to the duly authorized enforcement agencies as appropriate or required.
• Develops policies and procedures and programs designed to encourage individuals to report compliance concerns without fear of retaliation.
• Oversees the compliance hotline, reporting, documentation, and investigation of compliance related issues.
• Develops and implements strategic goals related to Compliance effectiveness and improvement, Compliance related risk assessments, auditing and monitoring, and training.
• Performs or directs through one or more designees, monitoring, auditing and other oversight activities of operational areas/functions, including activities delegated to First Tier, Downstream, and Related Entities (FDRs).
• Works with Operational Departments to ensure that policies and procedures are developed and modified to comply with Medicare, Medicaid, federal, and state regulatory standards. Provides guidance, in consultation with Legal Department (as appropriate), to various departments with respect to regulatory and contract language.
• Ensures routine exclusion and sanction monitoring is performed for all Monogram Health employees, contractors, and vendors to ensure licensure status and compliance with federal, state, and payor standards. Works with the Human Resources Director to investigate discovered concerns.
• Serves as the Monogram Health HIPAA Privacy Officer, overseeing the implementation and enforcement of Monogram Health HIPAA Privacy Policies, including:
• ensuring HIPAA compliant BAAs are in place with Monogram Health’s customers, business associates and subcontractors.
• training workforce members on Privacy Policies.
• responding to patterns of activity or practices that constitute violations of Privacy Policies.
• overseeing prompt and appropriate investigation and resolution of incidents or complaints.
• implementing steps necessary to mitigate harm caused by violations of the HIPAA Rules or Privacy Policies.
• receiving, processing and implementing requests related to patient rights.
• maintaining documentation required by Privacy Policies.
• making required HIPAA-related reports to patients, the media and HHS and being the point person for interacting with patients and third parties for issues related to compliance with the HIPAA Rules.
• Reviewing and revising Privacy Policies as necessary to comply with the HIPAA Rules and changes to Monogram Health’s operations.
• Ensures compliance reports are prepared for presentation to the Compliance Committee and the Board of Directors.
  

Position Requirements

• Bachelor’s degree Healthcare Administration, Business Administration, or related field or equivalent experience required. Master's degree Healthcare Administration, Business Administration, or related field preferred.
• 7 years of Medicare Managed Care compliance experience required, ideally with expertise in Special Needs Plan Model of Care (SNP MOC) requirements.
• Currently licensed as a Registered Nurse preferred.
• 1 years Overseeing implementation of contract requirements, required.
• 5 years of experience in a leadership role required.
• Personal Characteristics: Detail oriented, able to work in a fast-paced environment, able to handle confidential information.
• Certifications and licenses: Must possess or obtain within 1 year of employment, Certification in Healthcare Compliance (CHC) by the national Healthcare Compliance Association (HCCA). Must possess or obtain within 2 years of employment, Certification in Healthcare Privacy Compliance (CHPC) by HCCA.