Regulatory Affairs Specialist at Partnership HealthPlan of California

Fairfield, California, United States -

Full Time

Start Date

Immediate

Expiry Date

12 May, 26

Salary

106466.89

Posted On

11 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

HIPAA Program Support, Fraud Waste and Abuse (FWA) Program Support, Regulatory Agency Liaison, Incident Investigation, Risk Assessment, Corrective Action Plans, Regulatory Reporting, DHCS Reporting, Data Analysis, Stakeholder Interface, Compliance Education, Investigative System Maintenance, Microsoft Word, Microsoft PowerPoint, Microsoft Excel, Microsoft Project

Industry

Insurance

Description

Overview 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 supportsthe plan’s compliance program and assists in efforts to be compliant with applicable laws, regulations, and policies. Responsibilities  Independently investigates privacy and fraud, waste, and abuse referrals ensuringcompliance with contractual, regulatory, and statutory requirements and timelines. Interfaces with internal and external stakeholders through investigations and fact gatheringand as necessary, makes recommendations to RAC leadership for the escalation ofinvestigations. Develops and delivers education to internal and external stakeholders to promoteawareness and understanding of privacy and FWA rules to mitigate risks. Maintains investigative system of record and is directly responsible for timely submissionof all regulatory reporting requirements. Using the appropriate DHCS reporting form, drafts initial reports, updated reports andfinal reports and submits timely to the designated DHCS reporting unit. Responsible for identifying trends and linking related cases to assist with trending patternsand maintaining accurate data for daily, monthly, quarterly, and annual privacy and FWAanalytics. Works directly with DHCS Privacy Officer to report privacy related incidents, provideupdates upon request, ensure timely filing requirements are met for all reports and followsup 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 asnew evidence is found, ensures timely filing requirements are met for all reported casesand 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 submissiontracking mechanism Secondary Duties and Responsibilities Assists Regulatory Reporting Analyst in the collection of data and other input forrecurring reports due to federal, state and other entities requirements. Assists in compiling information into required format and performs quality check foraccuracy. Assists Regulatory Affairs and Compliance unit with the administrative functions tosupport unit meetings, workgroups, committees and/or projects. Other duties as assigned. Qualifications Education and Experience Bachelor’s degree in relevant field preferred, two – three (2-3) years of experience in the health care field, managed care experience preferred, with knowledge of the Knox-Keene, Medicare, Medi-Cal, and Healthy Families regulations; or an equivalent combination of education and experience. Special Skills, Licenses and Certifications Highly proficient in applicable business software applicationsincluding PC usage, Microsoft Word, PowerPoint, Excel, Project,typing speed of 30 wpm. Bilingual skills in a Partnership threshold language may be preferred. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent oral and written communication skills. Excellentorganizational skills with ability to prioritize assignments, maintaineffective filing systems, and meet deadlines. Ability to work underminimal supervision and exercise independent judgment. Diplomacyand tact in handling sensitive information regarding personnel affairs as required. Ability to interact with executives and vendors effectively, handling all assignments with efficiency. Must be able to handle multiple tasks and meet deadlines. Excellent judgment. Work Environment And Physical Demands Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 35 pounds. 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.

Responsibilities

This role supports the plan-wide HIPAA and Fraud, Waste, and Abuse (FWA) programs by coordinating investigations into potential incidents, assessing risks, and developing corrective action plans under RAC leadership supervision. Key duties include independently investigating referrals, interfacing with stakeholders, developing educational materials, maintaining records, and ensuring timely submission of all regulatory reports to agencies like DHCS.