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.
SECONDARY DUTIES AND RESPONSIBILITIES
Education and Experience
Bachelor’s Degree in Business, Communication, Healthcare
Special Skills, Licenses and Certifications
HCCA Certified in Healthcare Compliance (CHC) or Certified in
Performance Based Competencies
Demonstrated leadership skills/experience. Ability to work within an
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:
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 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.