Compliance & Privacy Program Specialist 25-00493

1. Responsible for supporting program development, implementation, and monitoring of intake and processes, inquiries, special projects, program initiatives, process improvement and operations.
2. Work cooperatively with the Compliance Program staff to develop, maintain, and update project, audit, investigation, and monitoring activities to ensure effective and timely completion. Identify changes and/or concerns in project plans, program activities, and communicate as appropriate to management.
3. Responsible for intake, pre-investigation activities, and tracking and monitoring all reported issues. Escalates high risk issues to staff and/or management, as appropriate.
4. Provide support to maintain the Compliance Department work plan, unit plan, and monitoring activities, including updates, tracking progress of scheduled activities, and regular status reports.
5. Maintain Unit/Department cases/files to ensure thorough, accurate, and complete documentation.
6. Create DTPs specific to workflows and procedures relevant to the role.
7. Assist with departmental office administration coordination, including word processing and other computerized applications, record management and general office management.
8. Support regular Department/Business Unit Touch Base meetings, including maintaining the agenda, maintaining, and tracking action items, and following up with the Compliance Department and impacted Business Units, as necessary.
9. Prepare ad hoc reports, charts, and graphs as needed to support the Compliance Program.
10. Be familiar with Federal and State regulatory requirements and respond timely to resolve issues.
11. Perform any other duties as assigned to ensure Compliance and Privacy Program operations are successful.
12. Ensure the privacy and security of PHI (Protected Health Information) as outlined in the company policies and procedures relating to HIPAA compliance.

• Three (3) years of experience in a healthcare environment specific to compliance program practices required
• Experience preferably in managed care
• High School diploma or GED required
• Associate's degree or Bachelor's degree from an accredited institution preferred
• Certification in healthcare compliance or similar compliance certification preferred

Key Qualifications

• Must have a valid California Driver's license
• Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred
• Demonstrated proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.) as tested by IEHP
• Excellent interpersonal skills
• Effective communication skills; verbal and written
• Ability to manage multiple projects with competing deadlines and changing priorities
• Ability to work independently with little direction on recurring tasks
• Willingness to provide department support on a wide range of operational activities
• Ability to establish and maintain effective working relationships with all levels of the organization
• Resourcefulness and independent in solving problems; strong attention to detail
• Interest in development of Compliance and Privacy SIU competencies and ethics