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Compliance & Privacy Officer, Santa Barbara, CA


Organization: CenCal Health
Category: Professional
Location: Santa Barbara, CA
Date Job Posted: July 10, 2020
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Compliance & Privacy Officer

Director COMPL01268
Posted: July 1, 2020
Full-Time
Santa Barbara, CA, USA

Job Details

Description

  • Implement and direct a Compliance Program that includes training programs, and related policies and procedures for employees, agents and contractors, which complies with all applicable federal, state and local laws and regulations
  • Coordinates and communicates to internal departments and external vendors, where appropriate all Medi-Cal compliance activities and programs as well as plans, implements and monitors the organization’s Medi-Cal compliance program
  • Develop and implement policies and procedures to prevent and detect fraud and abuse, address specific areas of suspected fraud and abuse and initiating a corrective action plan
  • Develop and implement methods and programs that encourage managers and employees to report suspected fraud and other misconduct without fear of retaliation Review all proposed legislation and regulations and ensure implementation of changes in law and regulation at the operation level
  • Develop and implement an internal risk assessment program to inform leadership of operational risks
  • Oversee CenCal Health’s Privacy Program and address any potential HIPAA privacy breaches internally or externally
  • Develop and implement internal monitoring/mock audit process for all key operational areas to ensure compliance with established policies, plans, procedures and performance standards
  • Ensure that internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct by employees, business partners, or others working with the organization
  • Oversee and coordinate all CenCal Health audits by regulatory agencies, including scheduling prep meetings, reviewing documentation to be used and ensure appropriate visibility
  • Oversee and coordinate all CenCal Health Corrective Action Plans (CAP) for implementation and submission to regulatory entities Facilitate improvement in response to compliance audits, satisfaction surveys or other data
  • Work with the General Counsel to ensure Board of Directors is informed of all compliance issues
  • Report all suspected fraud and abuse to DHS and work with legal counsel and certified fraud investigators on fraud investigative activities and corrective actions
  • Develop and maintain strategic relationships with regulatory agencies and key constituents relative to Regulatory Submissions, Audits and Corrective Action Plans, Delegation Oversight, Regulatory Review and Analysis
  • Communicate current state of legislative issues to management and the commission recommending the organizations position. Make presentations to the Board of Directors and Executive Team on status of legislative information
  • Other duties as assigned

Qualifications

Behaviors

Required

  • Thought Provoking: Capable of making others think deeply on a subject
  • Functional Expert: Considered a thought leader on a subject
  • Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
  • Leader: Inspires teammates to follow them

Education

Preferred

  • Masters or better in Health Administration or related field.

Experience

Required

  • Expert level understanding of HIPAA, Privacy Act, FWA, and ERISA
  • Must have demonstrated knowledge of Medicare and/or Medicaid regulations and experience with applying those regulations into a compliance framework
  • 6-7 years: Experience in health care related field with at least five (5) years in a progressive leadership role in Compliance and/or Regulatory Affairs within a managed care setting
  • 5-9 years: Leadership experience and ability to direct department personnel at all levels

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