Regulatory Affairs Manager
Job ID 2022-2202 FLSA Status Exempt
Responsible for leading and managing employees in the assigned areas of responsibility within
the Regulatory Affairs Unit. Manages and maintains relationships with state and federal
regulators. Responsible for managing the plan’s HIPAA and Fraud, Waste, and Abuse (FWA)
program to ensure plan is within compliance. Develops reports and present information to all
levels of PHC leadership. Oversees the day to day operations related to the investigation, case
management and reporting of potential privacy and FWA incidents to ensure the timely
submission of all regulatory reporting requirements are met. Also responsible for managing the
validation and submission processes related to enterprise wide regulatory reporting requirements.
- Provides daily direction to direct reports and is responsible for management, including timecards, performance discussions, mentorship, and development plans.
- Assigns workload and monitors performance, evaluates priority level and makes changes as necessary.
- Meets with direct reports to review project and program status on a routine basis, provides feedback and guidance where appropriate.
- Promotes team development and works with direct reports to establish development plans.
- Coaches and mentors Regulatory Affairs Unit staff.
- Identifies, monitors and evaluates unit’s operations to ensure optimal efficiency and effectiveness.
- Manages and maintains relationship through communications with DHCS and DMHC as one of HealthPlan’s primary contacts as well as communicates routinely with DHCS Privacy Officer, DHCS Program Integrity Unit, DHCS Audit & Investigation Unit, California’s Department of Justice and the Office of Civil Rights.
- Develops tools and standard processes to ensure regulatory reporting requirements and other ad hoc deliverables such as inquires, surveys or request are submitted timely.
- Works closely with other departments on responding to inquiries, surveys and other ad hoc requests from regulatory agencies.
- Works collaboratively with department subject matter experts (SME) to implement new regulatory reporting requirements or templates and assist in troubleshooting regulatory reporting issues.
- Responsible for managing duties that ensure the accuracy, completeness and truthfulness of enterprise wide regulatory reporting including data, information and documentation submitted to regulatory agencies.
- Manages the tracking, monitoring and communication of regulatory communications to impacted areas and Senior Management
- Chairs meetings related to compliance including the Physical Technical, and Administrative Safeguard Sub-Committee and Fraud, Waste and Abuse Sub-Committee as well as those related to regulatory requirements or regulatory reporting changes.
- Works with PHC’s Privacy Officer to develop, implement and maintain the organizations privacy policies, procedures, and guidelines in compliance with federal and state laws.
- Acts as designee for Compliance Office and Privacy Officer to independently investigate and act on compliance, privacy and FWA related activities including internal investigations, hotlines calls, or other issues reported and implementing corrective action plans as appropriate.
- Maintains a modified caseload in the area of assignment including escalated or sensitive cases involving employees in which is responsible for conducting investigations including interviewing employees, collecting and maintaining documentation, and providing recommendations to Compliance and/or Privacy Officers as appropriate.
- Prepares routine privacy risk assessment and presents recommendations to PHC’s Privacy Officer and other Senior Leadership.
- Manages the tracking and trending of privacy and FWA cases to identify systemic issues, problem providers and/or members
- Collaborates with satellite and regional offices to standardize plan wide privacy practices.
- Develops and implements departmental goals annually designed to increase performance and efficiency of unit.
- Develops or oversees the development of compliance trainings, including:
- New hire compliance training and Compliance Primers,
- Annual compliance training – HIPAA, FWA, and Code of Conduct
- Annual Compliance Plan training
- Targeted departments – as applicable on topics identified through tracking and trending of privacy or FWA incidents as well upon request by departments for refresher trainings or other topics requested, and;
- Other mandatory compliance trainings
- Manages the maintenance of the Regulatory Affairs and Compliance dashboard:
- Monthly reporting of privacy, FWA, and compliance issues statistics.
- Reports statistics to PTAS Sub-Committee, FWA Sub-Committee and Compliance Committee.
- Delegation Oversight responsibilities including auditing and monitoring of compliance with privacy, FWA and other regulatory reporting requirements.
SECONDARY DUTIES AND RESPONSIBILITIES
- Researches complex regulatory related inquires, provides accurate and timely responses utilizing all applicable State and Federal regulations
Education and Experience
- Bachelor’s Degree in Business, Communication, Healthcare Administration, Business Administration, or related field; a minimum of 2-3 years of experience in the health care field, managed care
experience preferred, with knowledge of Medi-Cal, Knox-Keene, and
Medicare regulations; or an equivalent combination of education and
experience. Minimum two (2) years of experience with conducting
privacy and/or fraud investigations preferred.
Special Skills, Licenses and Certifications
- HCCA Certified in Healthcare Compliance (CHC) or Certified in
Healthcare Privacy Compliance (CHPC) preferred. Solid collaboration and facilitation skills required. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business
Performance Based Competencies
- Demonstrated leadership skills/experience. Ability to work within an
interdisciplinary structure and function independently in a fast-paced
environment while managing multiple priorities and deadlines.
Excellent oral and written communication skills. Excellent
organizational skills required. Diplomacy and tact in handling sensitive information regarding personnel affairs as required. Ability to interact with executives and vendors effectively, handling all assignments with efficiency. Excellent judgment.
Work Environment And Physical Demands
- More than 50% of work time is spent using a desktop computer. When necessary, the ability to lift, carry, or move manuals and reports, weighing up to 25 lbs. Ability to travel as needed. Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. Ability to function effectively with frequent interruptions and direction from multiple team members.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.