Overview
The Compliance and Privacy Specialist is responsible for the synchronization of compliance and privacy operations. This includes functioning as an internal monitoring arm for AHN Compliance and Privacy. The Compliance and Privacy Specialist will assist with the management of maintaining focus on health care corporate regulatory and contractual compliance (including fraud, waste, and abuse), privacy compliance, and identifying and addressing any other issues which may negatively impact the organization’s reputation. This position will ensure regular, periodic reviews are conducted, will monitor compliance baselines, and will assist with identifying potential risk areas. Supporting leadership across the organization, the Compliance and Privacy Specialist will also provide research and technical assistance to ensure informed decision-making.

Responsibilities
Assists the Compliance and Privacy Office AHN with the development, implementation and administration of an effective Compliance and Privacy program. This includes:

Assisting with research and analysis of regulatory and contractual requirements.

Collaborating with appropriate departments and divisions to ensure that AHN’s employees and operations adhere to federal and state laws, health care program requirements and payor contract requirements.

Preparing AHN for audits and ensuring the satisfactory passing of the audits.

Provide timely, accurate and complete reports and communicate findings.

Facilitating the annual training, education, and public awareness elements of the Compliance and Privacy Program.

Assists in proactively identifying and communicating deficiencies or issues related to compliance and privacy and provide guidance in the development of alternative solutions.

Assists with the investigation of allegations of non-compliance and/or privacy breaches and with the coordination of any corresponding activities including, but not limited to, serving as a liaison with counsel and as appropriate, law-enforcement, regulatory agencies, and payors; and developing the investigation reports.

Assists with the administration of the compliance management system.

Monitors compliance activities and projects. This includes tracking success measurements through a routine dashboard.

Assists with the pro-active identification of significant business risk. This includes reviewing reports, records, and performance monitoring mechanisms, as well as conducting research, data analysis and report development.

Coordinating internal and external audit activities, including audit preparation and corrective action planning activities.

Monitoring corrective action plan implementation and initiating remedial measures to address implementation challenges.

Scheduling and participating in compliance-related meetings and participating in entrance and exit conferences for external program reviews.

Performing other related duties as assigned.

Qualifications
Bachelor’s degree required

Minimum of 4 years of compliance experience required.

Knowledge of Managed Health Care, Knox Keene, and government programs (i.e., Medicare, Medicaid, Medicare-Medicaid “Duals”) and HIPAA.

Bilingual: English/Spanish preferred.

Certification in Health Care Compliance preferred.