Under supervision of the Regulatory Affairs and Compliance (RAC) leadership, this supports the plan-wide HIPAA program and Fraud, Waste, and Abuse (FWA) program and acts as a liaison between the plan and our regulatory agencies. This position coordinates daily efforts between departments to conduct investigations into potential privacy or FWA related incidents, assess and mitigate risk as well as develop corrective action plans when applicable. This position supports
the plan’s compliance program and assists in efforts to be compliant with applicable laws, regulations, and policies.

 Independently investigates privacy and fraud, waste, and abuse referrals ensuring
compliance with contractual, regulatory, and statutory requirements and timelines.
 Interfaces with internal and external stakeholders through investigations and fact gathering
and as necessary, makes recommendations to RAC leadership for the escalation of
investigations.
 Develops and delivers education to internal and external stakeholders to promote
awareness and understanding of privacy and FWA rules to mitigate risks.
 Maintains investigative system of record and is directly responsible for timely submission
of all regulatory reporting requirements.
 Using the appropriate DHCS reporting form, drafts initial reports, updated reports and
final reports and submits timely to the designated DHCS reporting unit.
 Responsible for identifying trends and linking related cases to assist with trending patterns
and maintaining accurate data for daily, monthly, quarterly, and annual privacy and FWA
analytics.
 Works directly with DHCS Privacy Officer to report privacy related incidents, provide
updates upon request, ensure timely filing requirements are met for all reports and follows
up on pending cases to confirm cases are closed with the DHCS Privacy Office.
 Works directly with DHCS Program Integrity Unit (PIU) and DHCS Audit &
Investigation Unit (A&I) to report potential FWA related cases, provides case updates as
new evidence is found, ensures timely filing requirements are met for all reported cases
and follows up on pending cases to confirm cases are closed with DHCS PIU or A&I.
 Distributes, collects and retains copies of completed compliance primers.
 Responsible for managing the RAC Inbox and RAC Reporting Inboxes, including:
o Researching regulatory related inquiries and provide response to inquiries;
o Coordinating plan responses to DHCS adhoc requests, surveys or questionnaires;

o Supports submission of regulatory required materials and maintains a submission
tracking mechanism

Secondary Duties and Responsibilities
 Assists Regulatory Reporting Analyst in the collection of data and other input for
recurring reports due to federal, state and other entities requirements.
 Assists in compiling information into required format and performs quality check for
accuracy.
 Assists Regulatory Affairs and Compliance unit with the administrative functions to
support unit meetings, workgroups, committees and/or projects.
 Other duties as assigned.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$85,173.51 - $106,466.89

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.