Compliance & Privacy Officer
at Health Plan of San Joaquin

Date Posted: 11/25/2018

Job Description

HPSJ's Compliance and Privacy Officer is responsible for establishing and implementing an effective compliance Program, including fraud, waste and abuse, to prevent illegal, unethical or improper conduct consistent with applicable laws, regulatory and accreditation standards and HPSJ policies.
Key responsibilities include:
  • Identifies, develops and implements or oversees the implementation of strategies; oversees the development of associated business plans.
  • Develops and is responsible for the implementation and oversight of HPSJ’s Compliance Program, Anti-Fraud Plan and Annual Compliance Work Plan.
  • Chairs the Compliance Committee and Privacy Security Operations Committee and ensures the committee meets the goals as outlined in the HPSJ Compliance Plan and Annual Compliance Work Plan; ensures all sub-committees to the Compliance Committees (when necessary) are formed and operate on a regular basis to meet their intent.
  • Monitors the performance of the compliance program, including privacy and fraud, waste and abuse, and related activities on a continuing basis.
  • Reviews and analyzes, or oversees the review and analysis of legislation and regulations to determine the impact on plan operations; identifies the need for new or revised policies, procedures, plan documents, etc.; makes recommendations to management; develops and implements as required.
  • Develops and implements communication and educational programs and activities for internal and external stakeholders on compliance, and regulatory and contract requirements in an effective and timely manner.
  • Conducts investigation of actual and potential privacy and fraud, waste and abuse violations by HPSJ employees , vendors and business associates; determines actions to mitigate violations and breaches; documents and reports to Executive Management or applicable regulators as required.
  • Assists internal departments with the implementation, maintenance and update of compliance activities, including new and revised policies, procedures and corrective action plans.
  • Leads the development and renewal of HPSJ’s state contracts and contract amendments.
  • Develops, implements and monitors vendor, administrative, and grant agreements/contracts processes.
  • Plans for and oversees annual external audits; responds to, logs and tracks deficiencies; develops and monitors corrective action plans.
  • Serves as the Plan’s contact for regulatory agency inquiries and issues; ensures that communication and responses are accurate and consistent.
  • Oversees the identification, preparation, maintenance and monitoring of appropriate and required data, records, reports and other documentation; includes regulatory filings.
  • Oversees the reviews and responses to requests and subpoenas for protected health information.  
  • Develops and conducts compliance and related training programs and activities for HPSJ employees and vendors in an effective and timely manner.
  • Fosters a work environment that respects the importance of the privacy of member, client and employee information.
  • Promotes and maintains, and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
  • Hires, develops and retains, and ensures that direct reports hire, supervise and retain a competent staff.

Job Requirements

Required Skills
Qualified candidates will have the following knowledge, skills and competencies:
 
  • Expert knowledge of applicable federal and state privacy laws, regulations and standards, including state sponsored programs, applicable to health plans.
  • In depth knowledge of health plan operations as they relate to compliance
  • In-depth knowledge of standard contract components and contract language specific to healthcare.
  • In-depth knowledge of health information systems and their impact on privacy issues.
  • In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
  • Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies; identifies, plans, leads and executes to meet changing organizational and community needs, and regulatory requirements.
  • Cultivates innovation: Creates new and better ways for the organization to be successful.
  • Drives results: Consistently achieves results, even under tough circumstances.
  • Drives engagement: Creates a climate where people are motivated to do their best to help the organization achieve its objectives.
  • Drives vision and purpose: Paints a compelling picture of the vision and strategy that motivates others to action.
  • Courage: Steps up to address difficult issues, says what needs to be said.
  • Nimble learning: Actively learns through experimentation when tackling new problems, uses both successes and failures as learning fodder.
  • Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
  • Strong skills in budget development and management.
  • Communicates effectively: Develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences.
  • Very strong presentation skills, with the ability to tailor presentations to a specific audience, and address and interact with large groups.
  • Very strong interpersonal skills, with the ability to establish and maintain effective working relationships with diverse individuals at all levels inside and outside of HPSJ.
  • Very strong collaboration skills, with demonstrated ability to create and foster a collaborative work environment, maintain effective, high performance teams, and organize people and resources to solve problems and identify business opportunities.
  • Very strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications.
  • Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
  • Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
  • Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
  • Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations.
  • Strong customer service orientation.
  • Ensures accountability: Holds self and others accountable to meet commitments.
  • Strong knowledge of change management theory, with ability to anticipate and implement effectively.
  • Promotes and maintains, and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
  • Very strong coaching/counseling skills, including the ability to function as a mentor to management and employees.
  • Ability to supervise staff, and ensure that direct reports supervise staff, in a manner that maximizes employee performance and business results.
  • Ability to treat confidential information with appropriate discretion.

 
Preferred
  • Familiarity with political, business, education, non-profit and other community leaders in San Joaquin County and/or surrounding areas.
  • Knowledge of the economic and healthcare issues, and issues affecting the underserved in San Joaquin County and/or surrounding areas.
  • Knowledge of the managed care industry, its products, services and major business processes.  
  • In-depth knowledge of federal and state and federal regulations applicable to managed care.

Required Experience
 
  • Bachelor’s Degree in Business, Public Administration or Health Administration; and
  • At least four years as a Corporate Compliance Officer in a health plan or delegated group; OR
  • At least six years as a Compliance Manager in a California health plan, including state-sponsored programs; and
  • At least five years supervisory experience.

 
Preferred
  • Master’s Degree in business, public health or similar.
  • Experience in a managed care health plan.
  • Experience in compliance in Medi-Cal.

Licenses, Certifications
Required
  • Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.
  • Certificate of Healthcare Compliance (CHC); Certified HealthCare Privacy Compliance (CHPC).

 
#HPSJ

Job Snapshot

  • Employee Type: Full-Time
  • Location: French Camp, CA
  • Experience: Not Specified
  • Date Posted: 11/25/2018

About Us

For over 20 years, Health Plan of San Joaquin (HPSJ) has delivered access to hands-on, high-touch, quality health care for our diverse Central Valley communities. We do this by remaining as we began: nimble, resourceful and local. After two decades of communitywide partnerships and service:

  • More residents want to be our members
  • More providers prefer to be in our network
  • Hundreds of community-based organizations continue to come to us, whether for leadership, to make common cause on behalf of the health and well-being of our residents, or to host health condition-focused outreach and initiatives

For HPSJ employees, our commitment is professional and our dedication is personal: To provide health care value and advance wellness through community partnerships. We are a mirror to the rich cultural diversity of our service area, San Joaquin and Stanislaus counties. Our employees appreciate several benefits while working for HPSJ, such as four medical plan options, dental, vision, three retirement plans, and the opportunity to collaborate with others who are dedicated to providing high quality healthcare to our members.

HPSJ Community Report – The Story of Us

Each of our over 300 HPSJ employees can take justifiable pride in the role they play to make possible access to quality health care for over 340,000 members. We invite you to walk through the HPSJ Community Report, and hope you find it informative. For each of us at HPSJ, it has generated justifiable feelings of personal and professional pride.

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