Regulatory Affairs Specialist

4 weeks ago

Fairfield, United States Partnership HealthPlan of California Full time

Overview:

Under supervision and direction of the Regulatory Affairs Manager, this position assists in supporting 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 supports the plans compliance program and assists in efforts to be compliant with applicable laws, regulations, and policies.

Responsibilities:
  • Works independently using critical thinking and analytic skills to conduct privacy risk assessments and investigates privacy incidents or potential FWA related cases
  • Uses all information gathered and/or evidence found during the investigation to determine the outcome of the investigation or escalates when appropriate to Regulatory Affairs Manager for a determination
  • Based on determination of the case outcome works with or meets with departments to mitigate future risk and develop corrective action plans, when applicable
  • Using EthicsPoint, manages privacy and FWA case load to ensure the timely submission of all regulatory reporting requirements as well as maintains complete and accurate documentation to support the outcome determination and/or findings for audit purposes
  • Using the appropriate DHCS reporting form, drafts initial reports, updated reports and final reports and submits timely to the designated DHCS reporting unit
  • Responsible for identifying trends and linking related cases to assist with trending patterns and maintaining accurate data for daily, monthly, quarterly, and annual privacy and FWA analytics
  • Works directly with DHCS Privacy Officer to report privacy related incidents, provide updates upon request, ensure timely filing requirements are met for all reports and follows up 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, provide case updates as new evidence is found, ensure timely filing requirements are met for all reported cases and follows up on pending cases to confirm cases are closed with DHCS PIU or A&I.
  • Responsible for maintaining compliance training program, including:
  • New hire compliance training,
  • Annual compliance training HIPAA, FWA, Code of Conduct, Compliance Plan as well as the testing and retention
  • Conduct targeted department trainings topics requested by departments and refresher trainings, or identified trends using privacy and FWA analytics - Distributes, collects and retains copies of completed compliance primers -Responsible for managing the RAC Inbox and RAC Reporting Inboxes, including:
  • Researching regulatory related inquiries and provide response to inquiries,
  • Coordinating plan responses to DHCS adhoc requests, surveys or questionnaires
  • Circulate DHCS guidance to appropriate stakeholders
  • Works with departments on regulatory required submissions, assists with determining if governing agencys approval is required, maintains a submission tracking mechanism, assists departments with additional information requests, provides department with final approval and maintains documentation of approval for audit purposes

SECONDARY DUTIES AND RESPONSIBILITIES

  • Assists Regulatory Reporting Analyst in the collection of data and other input for recurring reports due to federal, state and other entities requirements
  • Assists in compiling information into required format and performs quality check for accuracy
  • Assists Regulatory Affairs and Compliance unit with the administrative functions to support unit meetings, workgroups, committees and/or projects - Other duties as assigned
Qualifications:

Education and Experience

Bachelors 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 applications including PC usage, Microsoft Word, PowerPoint, Excel, Project, typing speed of 30 wpm. Valid California drivers license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance

Based

Competencies

Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments, maintain effective filing systems, and meet deadlines. Ability to work under minimal supervision and exercise independent judgment. Diplomacy and 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 HealthPlans policies and procedures, as they may from time to time be updated.
HIRING RANGE:

$ 34.64 - $ 45.04

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.

  • Regulatory Affairs Specialist

    3 weeks ago

    Fairfield, United States Partnership HealthPlan of California Full time

    Overview: Under supervision and direction of the Regulatory Affairs Manager, this position assists in supporting 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...

  • Regulatory Affairs Sr Manager

    2 weeks ago

    Fairfield, New Jersey, United States Vantage Specialty Chemicals Full time

    Vantage is a leading supplier of naturally derived specialty ingredients and formulations that cater to the evolving needs of industrial and consumer markets. Through our chemistries, our customer focus and our global footprint, we are ENABLING TOMORROW'S SOLUTIONS TODAY. As a company on the move, you'll be working as part of a collaborative team and getting...

  • Regulatory Affairs Sr Manager

    1 month ago

    Fairfield, United States Vantage Specialty Chemicals Full time

    Vantage is a leading supplier of naturally derived specialty ingredients and formulations that cater to the evolving needs of industrial and consumer markets. Through our chemistries, our customer focus and our global footprint, we are ENABLING TOMORROW'S SOLUTIONS TODAY. As a company on the move, you'll be working as part of a collaborative team and getting...

  • Regulatory Affairs and Compliance Program Analyst

    2 weeks ago

    Fairfield, United States Partnership HealthPlan of California Full time

    Overview: To support the objectives of the regulatory and compliance program and to ensure related activities are in alignment with regulatory requirements, contractual obligations, and ethical standards. **Responsibilities**: - Maintains awareness and demonstrates understanding of regulatory requirements, contractual obligations and professional standards...

  • Regulatory Affairs Associate

    2 weeks ago

    Fairfield, New Jersey, United States Actalent Full time

    Great Regulatory Affairs opportunity to work with a leader in chemical ingredients for consumer products Description: This person will be responsible for CRM Clean-up and Data Migration clean-up They will review all compliance documentation for personal care products They will be utilizing databases, interacting with customers and suppliers Technical writing...

  • Regulatory Reporting Analyst

    2 weeks ago

    Fairfield, United States Partnership HealthPlan of California Full time

    Overview: To develop and implement long-term quantitative analysis strategies to meet NCQA and DHCS standards for reporting. To perform, and assist in the performance of, duties that ensure the accuracy, completeness and truthfulness of enterprise wide regulatory reporting including all data, information and documentation submitted to PHC’s governing...

  • Regulatory Windchill Coordinator

    3 weeks ago

    Fairfield, United States The Fountain Group Full time

    Pay: $35-40/hr Location: Sylmar, CA - first 2-3 weeks of training must be onsite and then may WFH the rest of the time with One Day In the Office. Duration: 6 months; possible temp to perm for candidates willing to come onsite Prefers candidates that are local to Sylmar so they may go into the office and also stand a better chance for conversion to FTE if...

  • Regulatory Windchill Coordinator

    4 weeks ago

    Fairfield, United States Blue Star Partners LLC Full time

    Job DescriptionJob DescriptionJob Title: Regulatory Windchill CoordinatorLocation: Fairfield, CA – Hybrid (1 day per week onsite) – Local candidates onlyPeriod: 08/02/2024 to 12/31/2024 – possibility of extensionHours/Week: 40 hours Rate: $40-$45/hour (Hours over 40 will be paid at Time and a Half)Contract Type: W-2Scope of Services:The Regulatory...

  • Regulatory Windchill Coordinator

    2 weeks ago

    Fairfield, United States Blue Star Partners LLC Full time

    Job DescriptionJob DescriptionJob Title: Regulatory Windchill CoordinatorLocation: Fairfield, CA – Hybrid (1 day per week onsite) – Local candidates onlyPeriod: 08/02/2024 to 12/31/2024 – possibility of extensionHours/Week: 40 hours Rate: $40-$45/hour (Hours over 40 will be paid at Time and a Half)Contract Type: W-2Scope of Services:The Regulatory...

  • Regulatory Windchill Coordinator

    4 weeks ago

    Fairfield, United States The Fountain Group Full time

    Bill: $60 Pay: $42-40 Spread:317.3-413.6 This is a non-exempt position. Position Summary: The Regulatory Windchill Coordinator provides support to the Regulatory Affairs team and is responsible for validating Global Regulatory Library (GRL) approval record metadata. Essential Functions: Using Search criteria to pull Regulatory Approval records information...

  • Regulatory Windchill Coordinator

    4 weeks ago

    Fairfield, United States Experis Full time

    Experis IT ManpowerGroup has partnered with a leading Medical device organization in the Sylmar, CAfor a Regulatory Windchill Coordinator role to assist their team. This is an on-site role. Industry: Medical device Title: Regulatory Windchill Coordinator Pay Rate:$35-40/hr on W2 Location: Sylmar, CA - first 2-3 weeks of training must be onsite and...

  • Executive VP, Scientific Affairs

    2 weeks ago

    Fairfield, United States Vital Health America, LLC Full time

    Job DescriptionJob DescriptionJob Summary: The EVP, Scientific Affairs oversees the operations of the Quality Assurance and Quality Control Departments for all divisions across multiple locations and has overall responsibility for the technical operations and the strategic planning of adequate resources needed to ensure the required quality of laboratory...

  • Executive Director Specialist RN

    2 weeks ago

    Fairfield, United States Gentiva Hospice Full time

    Our Company:  Gentiva is an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may make the most of every moment. We believe that better care for caregivers and clinicians means better care for...

  • Executive Director Specialist RN

    3 weeks ago

    Fairfield, United States Gentiva Hospice Full time

    Our Company:  Gentiva is an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may make the most of every moment. We believe that better care for caregivers and clinicians means better care for...

  • Documentation Specialist

    1 month ago

    Fairfield, United States Swift Staffing Inc Full time $20 - $22

    We are looking for highly meticulous, organized candidates for the position of documentation specialist. Documentation specialists are responsible for outlining a long-term storage strategy, working with colleagues to ensure consistency of documentation practice across the company, and training employees on efficient documentation usage, among other...

  • EHS Specialist

    2 months ago

    Fairfield, United States International Staffing Consultants, Inc. Full time

    Manufacturing company based out of Fairfield, CA is currently looking to bring on an EHS/Safety Specialist. This person will support "day to day" safety and EHS functions, working with internal employees, management, and outside vendors and agencies.This person will be working across compliance, safety assessments, risk, and reviews.Maintain relevant EHS...

  • Provider Systems Data Specialist II

    5 days ago

    Fairfield, United States Partnership HealthPlan of California Full time

    Overview: To maintain accurate provider information by entering necessary data elements into several database systems. Works closely with team members and other departments to research and resolve routine and complex issues and inquiries related to provider data. In addition to the Provider Systems Data Specialist I duties, the Provider Systems Data...

  • Provider Systems Data Specialist II

    1 week ago

    Fairfield, United States Partnership HealthPlan of California Full time

    Overview: To maintain accurate provider information by entering necessary data elements into several database systems. Works closely with team members and other departments to research and resolve routine and complex issues and inquiries related to provider data. In addition to the Provider Systems Data Specialist I duties, the Provider Systems Data...

  • Environmental, Health and Safety Specialist

    2 months ago

    Fairfield, United States Jelly Belly Full time

    The Environmental, Health and Safety Specialist (EHS) is responsible for maintaining the health and safety of the plant workforce and environment by monitoring and evaluating health and safety conditions; assuring compliance with applicable policies and governmental standards; and maintenance of the EHS programs, policies, and procedures for the site. The...

  • Specialist I, Quality Assurance

    3 weeks ago

    Fairfield, United States SGS Full time

    **Company Description** SGS is the global leader and innovator in inspection, verification, testing and certification services. Founded in 1878, SGS is recognized as the global benchmark in quality and integrity. With over 97,000 employees in 130 countries and operating a network of more than 2,400 offices and laboratories, we provide services to almost...