Compliance & Privacy Officer (Director Level)

Hawaii Dental Service•Honolulu, HI

9d•Hybrid

About The Position

Directs Hawaii Dental Service’s (HDS’s) efforts to ensure compliance with applicable laws, regulations, rules, DDPA standards, policies and procedures, and functions as the HDS HIPAA Privacy Officer. This position is responsible for developing, implementing and managing the HDS Business Ethics and Legal Compliance Program (”Compliance Program”), the HDS Fraud and Abuse Program, the HDS Privacy Program, company-wide compliance training and monitoring activities, and required reporting. Serves as the focal point for HDS compliance, privacy, and fraud and abuse activities, and acts as a compliance liaison for outside counsel, DDPA, federal and state law enforcement, and external auditors. Manages activities of the Compliance Department and supervises compliance and internal audit professionals. As a member of the management team, this position is actively involved in company operations, and supports the strategic objectives of HDS. Also functions in similar compliance capacity for Hawaii Client Services (HCS).

Requirements

Bachelor's degree in business administration or an equivalent combination of education, training or working experience.
Minimum of 5 - 10 years professional/management level experience in compliance, internal audit and/or other relevant experience.
Minimum of 2 years of experience managing/supervision of staff.
Requires use of leadership skills, creativity, problem-solving and working under limited supervision.
Strong management and delegation skills to meet deadlines and complete tasks efficiently through others.
Requires continuously finding new and better ways of performing job, seeking solutions and exercising good judgment.
Requires working under frequent deadlines and pressures, dealing with difficult people or situations involving complex issues, negotiating, establishing and maintaining cooperative and productive business and work relationships.
Ability to learn, thoroughly comprehend and communicate regulations
Ability to handle confidential and sensitive issues and materials
Ability to assess, develop and implement programs, policies and procedures
Detail oriented with strong analytical, research, problem solving and reasoning skills
Working knowledge of PC applications (i.e. Windows, Word, Excel and Powerpoint), including ability to understand interrelationship of multiple system applications.

Nice To Haves

Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified Information Privacy Processional (CIPP), and/or Certified Billing and Coding Specialist (CBCS) preferred.

Responsibilities

Develops, implements, evaluates and recommends best practices to ensure effective work processes and systems, maximize operating efficiencies and increase the value of services provided in alignment with department and company goals and objectives.
Manages the participating dentists’ in-office, remote, and peer reviews.
Notifies dentists of non-compliance with HDS contract document and negotiates and executes settlement agreements with assistance from General Counsel.
Coordinates repayment plans with the HDS Controller.
Presents recommendations for dentists’ HDS membership terminations or suspensions to the General Counsel.
Investigates suspected employee, provider and vendor fraud and abuse cases, reports results to the General Counsel, recommends corrective actions and coordinates them with HR and others, as required.
Manages fraud and abuse cases with federal and state law enforcement agencies, as needed.
Develops and provides fraud and abuse training.
Develops, implements and manages company-wide monitoring .
Reviews processes within and among HDS departments for efficiency, effectiveness and compliance with regulations and DDPA standards. Recommends solutions to correct identified deficiencies and cost-effective enhancements to operational processes.
Reports on service guarantees for employer groups.
Manages and coordinates the external audits with the department managers and external auditors.
Monitors implementation of corrective actions, as necessary.
Develops, implements, evaluates and recommends controls to satisfy operational/compliance risk requirements, ensure data integrity and best practices.
Keeps abreast of current regulations and compliance issues that may impact the department and company.
Manages the HDS Compliance and Privacy Program.
Manages compliance hotline.
Functions as HIPAA Privacy Officer.
Develops and implements privacy policies in compliance with federal and state law.
Performs privacy risk assessments and related compliance monitoring activities.
Develops and implements privacy training and orientation to all employees.
Reviews, executes and manages Business Associate agreements.
Manages and coordinates the DDPA surveys regarding HDS's compliance with the DDPA standards.
Develops and provides compliance training.
Acts as a compliance consultant to assist other departments in understanding and complying with applicable laws, regulations, rules, DDPA standards, policies and procedures.
Supervises/Manages the following staff: Direct Reports: 3 Compliance Analysts.
Manages, plans, organizes, supervises, trains, motivates and evaluates staff; including making final hiring & termination decisions, assigning work, developing growth opportunities, conducting performance evaluations and taking corrective action.
Communicates and assures that employees have a clear understanding of performance expectations and responsibilities.
Plans, directs and manages toward effective and appropriate activities and ensures satisfactory performance of those employees.
Develops and manages annual budget in alignment with company goals and objectives.
Develops long and short-term strategic plans concerning successful operation of the Compliance department.
Develops, implements, evaluates and effectively communicates to compliance and audit professionals performance expectations, goals and responsibilities in alignment with company-wide objectives and goals.
Develops, implements, and enforces departmental policies and procedures.
Ensures initial and recurrent training occurs.
Plans, directs and manages the activities related to the department.
Monitors productivity and performance while ensuring professionalism, quality, timeliness and accuracy in accordance with overall company-wide objectives to ensure positive working relationships with internal and external customers.
Functions as a compliance and internal audit liaison for outside counsel, DDPA, federal and state law enforcement, and external auditors.
Performs other related duties as required or assigned.