Sr. Program HIPAA Manager (Compliance Required) - REMOTE

JOB SUMMARY (Purpose of the job and high-level summary of duties):

The Sr. HIPAA Program Manager position is primarily responsible for investigation known or suspected privacy incidents.   

JOB DUTIES (Main duties & responsibilities of the role):

• Respond to allegations of privacy and/or security violations. Conduct the investigation of privacy and/or security incidents involving members, providers, subcontractors, and employees.

• Analyze data, contract terms, and other documentation to substantiate and/or unsubstantiate privacy allegations and identify potential patterns. Apply regulatory and contractual requirements as well as internal policies and procedures to the incident investigation process.

• Perform data analysis, research, and review of privacy violations to identify trends, patterns, outliers. 

• Conduct investigations and interviews to gather additional evidence.

• Research and investigate member and/ or health plan cases through internal Alertline; 

• Communicate with regulators, outside counsel, members, providers, and internal stakeholders routinely regarding issues including investigative findings.

• Compile, report, and present privacy incidents to the appropriate regulatory agency. 

• Maintain the integrity of documentation for privacy incidents. Update case management system to ensure documentation of all calls, evidence, referrals, inquiries, and case events are accurate for record keeping purposes and for “Discovery” in court related cases.

• Establish and maintain strong relationships with external agencies including the U.S. Department of Health Services Office for Civil Rights, State Medicaid agencies, Departments of Insurance, Office of Inspector General, state professional licensing boards, FBI, and state/local law enforcement.

• Prepare data requests from external regulatory agencies as required.

• Use findings to determine where there is a need for a CAP action based online of business, severity of issue, regulatory compliance requirements and plan exposure. 

• Develop and maintain relationships with key business units within specific product line and geographic 

region.

JOB PROFILE

• Provides direction, instructions, and guidance to Investigative team.

• Performs other duties as assigned.

REQUIRED EDUCATION:

• Associates degree or Bachelor’s degree in Health Information Management, Health Care Administration, Business Administration.

Finance, IT Security, Criminal Justice, Legal, Law Enforcement or related field (applicable privacy program experience would be accepted in lieu of education experience).

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• At least five (5) years’ experience working in a Managed Care Organization, health insurance company or financial services.

• Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions.

• Proven ability to research and interpret regulatory requirements.

• Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.

• Excellent oral and written communication skills. 

• Intermediate/ advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet.

• Strong logical, analytical, critical thinking and problem-solving skills.

• Initiative, excellent follow-through, persistence in locating and securing needed information.

• Ability to multi-task and operate effectively across geographic and functional boundaries.

• Detail-oriented, self-motivated, able to meet tight deadlines.

• Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.

• Energetic and forward thinking with high ethical standards and a professional image.

• Collaborative and team-oriented.

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

JOB PROFILE

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Certified International Privacy Professional (CIPP/US)

• Certified Healthcare Compliance (CHC) 

• Certificates /designations and/or advanced training in healthcare privacy 

 

STATE SPECIFIC REQUIREMENTS:

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be mad