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Regulatory Compliance Specialist

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MetroPlus Health PlanRussell, IA
  • About NYC Health Hospitals MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  • As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
  • For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • Position Overview The Privacy Specialist reports to the Director of Corporate Compliance and Privacy.
  • Job Description Assist the Director of Corporate Compliance and Privacy in the development of the annual risk assessment and implementation of the annual work plan.
  • Conducts privacy investigations.
  • Ensures all privacy requirements for notifications are met, including issuing breach notifications when necessary and assisting with annual mailings.
  • Manage the Privacy Officer email inbox, including tracking and addressing inquiries.
  • Research any Privacy or Corporate Compliance related issues and responding to any concerns.
  • Works cross functionally with departments across the company to ensure the implementation of state and federal policy changes and updates for privacy and compliance activities.
  • Supports the regular development and review of Compliance and Privacy policies and procedures for the general operation of the Plan’s Corporate Compliance and Privacy Program.
  • Conducts auditing and monitoring activities for Corporate Compliance and Privacy as outlined in the Annual Work Plan. Support the Director of Corporate Compliance and Privacy with any required regulatory reporting.
  • Contributes quality and timely data for the materials prepared for the Fraud, Waste and Abuse Committee, Internal Compliance Committee Meetings and Audit and Compliance Subcommittee of the Board of Directors.
  • Upon identification of non-compliance, provide support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance and Privacy review.
  • Plays a critical role in driving the progress for corrective action plans throughout the organization.
  • Coordinates the support for business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements.
  • Other duties as assigned or requested.
  • Minimum Qualifications Knowledge and understanding of applicable privacy laws and regulations such as 42 CFR Part 2, HIPAA, NYS Mental Hygiene Laws, etc.
  • A Bachelor’s degree required.
  • 3-5 years of Managed Care experience.
  • 3-5 years’ experience in a privacy function within a Managed Care Organization, preferred.
  • Prior successful experience working with regulators privacy and compliance audits, reporting and other matters.
  • Experience managing complicated projects, keeping track of details, and staging work to deliver projects Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results.
  • Experience with developing reporting and metric.
  • Professional Competencies Solid Microsoft Excel skills and strong proficiency using MS Word and PowerPoint Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles.
  • The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
  • Extensive knowledge of HIPAA, New York State Privacy Regulations, data privacy, and/or data security processes.
  • Experience working with regulators on compliance audits, reporting and other matters.
  • Experience with managed care, Medicaid and federal regulations, quality improvement and compliance oversight.
  • High-level of skill in leading interdepartmental and cross-functional projects; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
  • Excellent oral, written, and presentation skills, state as well as conceptual and analytic skills are necessary to review and articulate corporate objectives and Federal regulations across all relevant audiences.
  • The utmost integrity in the discreet and confidential handling of confidential materials is necessary.

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