Compliance and Privacy Business Partner (44744)

The Compliance Business and Privacy Partner (CBPP) is responsible for aligning business objectives by providing regulatory support and compliance and privacy oversight for designated departments across the organization. This position will partner with the staff and leadership of assigned departments to identify compliance risk and issues of noncompliance, oversee correction of noncompliance, and provide regulatory interpretation.

The Business Partner assesses and anticipates Compliance-related needs and communicates needs proactively business management to seek and/or develop integrated solutions to mitigate risk. Using both formal and informal risk assessments, results of compliance monitoring and auditing, and other intel, this role will seek to assess compliance with policies and procedures, federal and State contracts, and laws and regulations as they pertain to accepted industry standards.

Duties and Responsibilities

Responsibilities include, but are not limited to, the following:

• Assists the Compliance and Privacy Officer with identification, oversight, ongoing monitoring, and corrective action where applicable, with all compliance and privacy related items
• Monitors business area processes and procedures against all applicable compliance and privacy requirements
• Participates in scheduled Compliance Committee meetings with respective business units from across the organization
• Provides interpretation of new, changed, or existing regulatory and contractual requirements. Assess potential impacts resulting from new or changed regulatory and contractual requirements
• Perform formal and informal risk assessments to identify compliance risk
• Establishes, builds, and fosters relationships with assigned departments and all levels of the organization
• Develops, tracks, and monitors internal audit corrective action plans to ensure that the organization is fully implementing required action plans
• Follows up, verifies, and evaluates the adequacy of post-audit corrective actions by re-examining procedures, observing revised processes and conducting follow-up audits, where necessary
• Collaborates with operational areas to develop and implement an internal regulatory compliance framework to promote compliance with laws, rules, and regulations that govern Neighborhood’s business activities
• Comply with all guidelines established by the Centers for Medicare and Medicaid Services (CMS) and guidelines set forth by other regulatory agencies including EOHHS and OHIC, and other areas where applicable
• Maintains in-depth knowledge of regulatory, subregulatory and other applicable requirements related to compliance and privacy, reducing organizational risks and ensuring regulatory compliance. Partners with the legal department as needed/required.
• Identifies compliance and privacy training needs for Organization and business units
• Participate in department continuous quality improvement activities
• Take responsibility for professional development, support a learning environment, and meet professional competency requirements.
• Other duties as assigned
• Corporate Compliance Responsibility – As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Qualifications

Required:

• Bachelor’s Degree in healthcare, or related discipline or sufficient experience and/or background to equate to the degree; or minimum of four (4) years experience working in a healthcare environment, with at least one (1) year working with/in a regulatory environment
• Ability to think analytically, communicate complex issues and develop control recommendations
• Project management experience
• Effective written and verbal communication, ability to present control analysis and recommendations with clarity and professionalism
• Builds Strong Relationships: Actively networks within the organization, building high quality relationships with management and line staff.
• Personal Drive to Succeed: Has ambition that is appropriately displayed through the quality of their work. Individual is driven by a strong internal desire to have impact and influence in the organization.
• Ability to prioritize tasks effectively and work independently
• Excellent written and verbal communication skills
• Strong interpersonal skills and customer service orientation
• Proven organizational skills and attention to detail
• Ability to maintain confidentiality
• Ability to take direction and support a multitude of individuals

Preferred:

• Detailed knowledge of government healthcare program regulations including the ability to read contracts
• Working knowledge of CMS/EOHHS/OHIC rules and regulations and familiarity with compliance tools (e.g., OMT/Gorman Tool)
• Two (2) to Four (4) years’ experience working in the area of health insurance compliance including Medicare or Medicaid compliance

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.