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Must have a functional understanding of federal/state regulations and compliance mandates, including but not limited to HIPAA, HITRUST, SOC, and other regulatory audits. Owns and oversees the disaster recovery plans; coordinates business continuity plans with the compliance and risk management team.
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Plans, coordinates, and manages all activities pertinent to the specific clinical trials, ensuring patient safety, good clinical practices, and compliance with the protocol and regulatory agencies.
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Designs educational strategies to assure compliance with regulatory standards for NCQA, HIPAA, CMS, and other local, state and federal organizations as applicable. Knowledge of hospital and department policies and procedures as well as knowledge of regulatory requirements relevant to the care management department.
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Regulatory Compliance: Ensures all areas of accountability are compliant with all federal, state and local regulatory standards and requirements, including DOH, TJC, FDA, HIPAA, HCFA, DPW, OSHA and others for practices under their leadership.
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Deep experience in operating risk and compliance standards, including PCI, HIPAA, and HITRUST, and enterprise risk management practices. Humana's Associate Vice President (AVP), Technology and Cybersecurity Risk works closely with all areas of Enterprise Information Protection (EIP), Internal Audit, Enterprise Risk Management, business units, regulatory agencies, and industry groups to ensure the company's technology and cybersecurity risks are effectively managed and compliance objectives are achieved.
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Possess CISSP certification (or similar) and knowledge of national and international regulatory compliances and frameworks such as ISO, SOX, BASEL II, EU DPD, HIPAA, and PCI DSS. Position Accountability / Scope - Reports to Sr. Manager of Governance, Risk & Compliance.
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Provide practical day-to-day legal, regulatory, and related business guidance on health care regulatory matters, HIPAA, employment laws, ERISA, or other Federal laws affecting health insurance and health plans.
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Completion of HIPAA Compliance Training. Completion of flu shot within flu season (as indicated by state regulatory agency). Two doses of MMR vaccine or serological testing for immunity to rubella and rubeola required.
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Ensure regulatory compliance with HIPAA, OSHA, labor laws, and other federal, state, and local regulations. Provide team-member and regulatory supervision, training, and support.
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Responsible for ensuring compliance with Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), Health Insurance Portability and Accountability Act (HIPAA), New Jersey Department of Health (NJDOH) regulatory requirements and HMH policies and procedures.
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Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare. Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse.
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Ensures clinic processes and workflows comply with regulatory and policy compliance such as infection control, OSHA, CLIA, Joint Commission, HIPAA, scope of practice, etc. Ensures clinic processes and workflows comply with regulatory and policy compliance such as infection control, OSHA, CLIA, Joint Commission, HIPAA, scope of practice, etc.
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Knowledge of regulatory guidelines to include, but not limited to, HIPAA, AHCA, EMTALA, and Medicare coverage structure, including medical necessity compliance guidelines. Bilingual English, Spanish/Creole.
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Ensure compliance with HIPAA policies and maintain confidentiality of medical records. Knowledge of regulatory standards such as NCQA, URAC, and the Parity in Mental Health and Substance Use Disorder Services Final Rule.
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Working under moderate supervision, in compliance with regulatory, HIPAA, organizational, and departmental policy and procedure; delivers basic and advanced diagnostic imaging services to patients ranging in age from neonate through geriatric, using radiographic procedures and related techniques to produce images for interpretation by, or at the request of, a licensed practitioner while maintaining the standards of ethics for radiologic technologists.
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