General Counsel Chief Compliance and Privacy Officer

Job Description

Job Description

Position: General Counsel & Chief Compliance and Privacy Officer

Department: Sr. Leadership

Reports To: General Counsel of HPI & Affiliate Groups

FLSA Status: Exempt

About HPI

At HPI, we are a forward-thinking, national third-party administrator (TPA) specializing in self-funded health plan solutions. With over 44 years of industry expertise, our entrepreneurial spirit, flexible approach, and personalized service have empowered us to serve clients of all sizes across diverse industries. We deliver innovative strategies that maximize the value of every healthcare dollar.

The self-funded health plan landscape is constantly evolving. At HPI, our partners benefit from having a TPA with the expertise, resources, and creativity to deliver customized plan solutions that help them win and retain more business. We excel at driving costs down and managing risk, while enhancing our clients’ employees’ health insurance experience. Our goal is to help members clearly understand their health plan and provide responsive service, enabling them to fully utilize their benefits and achieve greater health.

Our commitment extends beyond our clients to our own employees. We foster a supportive and inclusive work environment where innovation thrives. By investing in our team’s growth and well-being, we ensure they are equipped to provide exceptional service.

Summary:

The General Counsel & Chief Compliance and Privacy Officer will be responsible for: building strategic and comprehensive legal, compliance and privacy programs that develop, implement and maintain policies, procedures, processes and programs that enable consistent, effective compliance and/or privacy practices, reduce legal risk, and ensure operations of the company are within legal obligations. The General Counsel & Chief Compliance and Privacy Officer will: 1) ensure compliance and adherence to applicable laws and regulations and accreditation standards; 2) minimize risk; 3) ensure the confidentiality of protected health information (“PHI”); and 4) promote a culture of compliance and adherence to applicable laws, regulations and accreditation standards throughout the HPI organization. In addition, the General Counsel & Chief Compliance and Privacy Officer will review documents, agreements, and contractual obligations and their terms while serving as a key resource to advise on risk mitigation, legal, compliance and/or privacy matters.

Duties and Responsibilities (other duties may be assigned):

• Lead and oversee the development, implementation, and on-going monitoring of the organization’s legal; compliance; and privacy programs.
• Analyze client, vendor, and other third-party requests for disclosure of PHI, identify and issue appropriate privacy-related agreements (e.g., Business Associate Agreement, Non-Disclosure Agreement). Review, draft and negotiate privacy related agreements. Maintain an agreement database.
• Develop, implement, review, update, and maintain privacy focused policies, procedures, processes, and programs. Maintain current knowledge of applicable privacy laws and regulations. Develop and implement changes to privacy focused policies, procedures, processes, and program as appropriate. Advise the organization on applicable legal, regulatory and compliance requirements related to privacy.
• Develop, implement, review, update, and maintain compliance focused policies, procedures, processes, and programs, including those needed to demonstrate a robust compliance program to accrediting agencies. Maintain current knowledge of applicable laws, regulations, and accreditation standards. Develop and implement changes to compliance focused policies, procedures, processes, and program as appropriate. Advise the organization on applicable legal, regulatory, compliance and accreditation requirements to ensure adherence.
• Manage the development, delivery, and completion of legal, compliance and /or privacy trainings. Review and update training materials on legal, compliance, accreditation and /or privacy topics. Create and deliver specialized educational programs for key roles and responsibilities that mitigate risk from the entities legal, privacy, compliance or accreditation obligations.
• Establish and Chair a Compliance Oversight Committee. Provide regular reports detailing privacy or compliance initiatives and the status of operational activity to senior management. Identify and present changes to legal, privacy, accreditation or compliance obligations and matters of significance or urgency to the attention of senior management. Recommend improvements to policies, procedures, processes, and program in order to risk mitigation and ensure adherence to legal, compliance, accreditation and/or privacy obligations. Develop and document an annual work plan of the Committee’s initiatives and activities.
• Coordinate and review all workflow to and through all external legal counsel for all areas, including in collaboration with Human Resources. Manage all outside counsel relationships including billing.
• Conduct and/or participate in annual privacy, security and compliance risk analysis and on-going monitoring activities.
• Participate in internal and external audits related to privacy, security, accreditation, and compliance practices. Oversee the implementation of corrective actions.
• Responsible for receiving, tracking, documenting, investigating (to include completion of a risk assessment) and taking action on all reports of (i) potential privacy related incidents or complaints; or (ii) compliance-related incidents or complaints including those related to accreditation. Direct the process for reporting incidents as required by applicable legal, accreditation or contractual obligations.
• Responsible for review, draft and negotiation of all contractual agreements.
• Function as a key resource to advise on internal organizational legal, compliance, accreditation, or privacy matters.
• Duties and projects, as assigned requiring legal, compliance, accreditation or privacy expertise as assigned by the President and CEO of MedWatch, LLC.
• The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.

Minimum Education Requirements (must have documented proof*):

• Bachelor’s degree and JD required.

• CIPP, CIPM, CHC, CHPC credential a plus.

Licensure/Certification Requirements:

• Admission to the Bar in one or more states where the Company does business.

Experience Requirements:

• 7 or more years of experience in health care privacy, legal and compliance matters required

Requirements/Skills:

• Experience with Utilization Review Accreditation Commission matters a plus.
• Experience with Service Organization Controls reporting and audits a plus.

Resilient, collaborative, flexible, innovative

Reasonable Accommodation:

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.

Working Environment/Physical Demands:

The work environment characteristics and physical demands described here are representative of those an employee may encounter while performing the duties of this job.

The noise level in the work environment is moderate. The employee may occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, walk, speak, or hear. The employee is frequently required to use hands or feel or handle items as well as reach with hands and arms. The employee is occasionally required to stand.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.

Health Plans Inc. is an EEO – M/F/D/V employer