A career at AllWays Health Partners is you in every way! Inspired by our affiliation with Partners HealthCare, our promise as a people-first organization starts with our employees. Get inspired to bring your unique talents to our diverse community and challenge the health care industry status quo with innovative programs that put people first. Our perks include a competitive benefits package, access to world-class doctors, and more.
The Director, Regulatory Affairs, Compliance and Privacy oversees AllWays Health Partners’ regulatory and compliance program to ensure compliance with state and federal laws, rules, regulations, and policies that govern its Medicaid, Medicare, Commercial, Health Care Connector and other insurance business. Provide supervision to the Legal, Regulatory Affairs and Compliance Department (“LRAC”) in the absence of the SVP, LRAC. This position includes the responsibilities of and designation as AllWays Health Partners Privacy Officer. The Director will collaborate with internal leadership as well as Partners Health Systems Office of General Counsel and Compliance, Audit and Business Integrity Departments.
Essential Functions: • Report directly to the SVP, Legal, Regulatory Affairs and Compliance and dotted line report to Partners Health System, Vice President for Compliance, Audit & Business Integrity. • Provide supervision to the Legal, Regulatory Affairs and Compliance Department in the absence of the SVP of Legal, Regulatory Affairs and Compliance. • Act as Chief Privacy Officer responsible to ensure compliance with and develop and manage policies and protocols to secure and protect health information. Work with AllWays Health Partners Security Officer. • Develop and maintain productive relationships with all levels of management, staff as well as regulators, government agency personnel and other relevant parties. • Work with operational leadership to provide support and information to ensure that they and their employees gain the requisite knowledge of regulatory issues and requirements and contractual obligations to carry out their responsibilities in a compliant, lawful and ethical manner. • Work and communicate effectively with Partners Health System Office of General Counsel, and Compliance, Audit and Business Integrity and Privacy Departments and others as needed to support functions, projects and requirements of AllWays Health Partners and the Legal, Regulatory Affairs and Compliance Department. • Maintain working relationships with regulators and others to clarify and resolve issues. Relevant agencies include Massachusetts DOI, Connector, EOHHS and federal CMS, CCIO and others. • Develop, implement, monitor and update policies, procedures and practices designed to promote compliance with the requirements set forth in Federal and State Health Programs. Document, maintain and audit a coordinated legislative and regulatory compliance program including development of data to measure and inform compliance and meet the expectations of regulators, accrediting bodies and corporate financial audit standards and measures performance. • Identify and assess areas of compliance risk for AllWays Health Partners. Develop and promote preventive strategies, processes and best business practices. • Collaborate with the Standards, Expectations and Compliance Committees to effectively incorporate the audit and compliance program into AllWays Health Partners operations. • Participate in the development, implementation and presentation of educational and training programs addressing compliance and privacy and incorporating regulatory and contractual changes affecting the Medicaid, Medicare and Commercial and other insurance products. • Develop and ensure that internal controls maximize and prevent significant instances or patterns of illegal, unethical or improper activities. • Support investigations with legal counsel for violations of law or policy. Conduct or oversee investigations as appropriate. Oversee and follow-up and, as applicable, implement corrective actions and other issues generated by the compliance program or regulatory activities. • Coordinate filing of regulatory forms and reports. Assist in researching and informing departments of regulations to develop procedures to comply, as well as drafting responses to queries by regulatory agencies or employer groups. • Responsible to conduct investigations and take action if there is a reported breach of privacy. In coordination with AllWays Health Partners Security Officer, develop and implement, mechanisms to oversee the application of privacy policies, including providing staff orientation and on-going training. • Develop and implement processes to review requests for the use of PHI, including review and approval of research requests, limited data set requests, business associate agreements and requests made by plan sponsors and regulatory agencies. • Develop and implement processes to detect and respond to unnecessary PHI collection and to privacy violations, including review of employee access to member records, review of information requests made by AllWays Health Partners and reporting mechanisms for privacy violations. • Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect. • Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort: • Work is normally performed in a typical office work environment.
Required: • Bachelor’s Degree or the equivalent combination of training and experience, plus a minimum of five to seven years related experience. • Seven years of management experience in a highly regulated industry, such as health insurance.
Preferred/Desired: • J.D. or Master’s degree preferred. • Previous accreditation, state or federal regulatory or managed care compliance experience, experience using the System for Electronic Rates & Forms Filing (SERFF), certified in Healthcare Privacy Compliance (CHPC); experience with commercial health insurance and ERISA.
Skills/Competencies: • Demonstrate AllWays Health Partners’ core brand principles of always listening, challenging conventions, and providing value. • High Integrity and EQ • Excellent judgment • Demonstrated ability to coach and mentor staff • Proven and effective leadership skills • Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner. • Strong influencing skills including perseverance, creativity and flexibility • Bring fresh ideas forward by listening to and working with employees and the people we serve. • Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence various targeted audiences • Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. • Excellent organizational and analytical skills. • Accountable for delivering high quality work. • Ability to work well both independently and as a key team member. • Ability to effectively present information and respond to inquiries from employees, senior management, regulatory agencies and business associates. • Ability to manage multiple projects, meet deadlines and adjust to changes in company policies, procedures and priorities. • Ability to read, analyze and interpret clinical research, general business periodicals, professional journals, government regulations and legal documents. Ability to write clear, concise reports, business correspondence and procedures. • Proficient in internet research • Proficient in Microsoft Office Products and adept at learning new platforms and functions
Certification or Conditions of Employment • Pre-employment background check • CORI background check, if applicable
Independent Action: • Frequent need to make decisions regarding the applicability and interpretation of complex regulations and requirements. • Consultation needed with supervisor when conflict exists with organizational needs and objectives and when AllWays Health Partners position on significant issues is advanced. • Work directly with Partners Health System departments including OGC, Compliance and Privacy
Organizational Relationships/Scope: • Report directly to SVP, LRAC • Work on cross-functional teams with Provider Audit, Product Development, Finance, Clinical, Provider Relations, Network Development, Customer Care, Claims, Information Technology, Corporate Communications, PPMO, and Business Development. • Communicate directly with external regulatory agencies, industry organizations, legislators and others.
EEO StatementOur promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification, and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.
Internal Number: 3107581
About AllWays Health Partners
A new kind of health plan built on the idea that insurance companies can work better. We’re offering a new approach — one that gives you more of what you want (like a strong and growing network, easy-to-understand plans, and speedy customer service) plus a few things you might not have ever expected — like our performance guarantees and customer loyalty program.
With over 30 years of experience, AllWays Health Partners comes from a tradition of innovation, value, and customer service created from the combined strengths of Neighborhood Health Plan and Partners HealthCare.
We’re passionate about challenging the status quo. And we’re just getting started. Whether through our online member community or our in-person advisory groups, we’re always listening to you to find new ways to solve old problems and to deliver the best possible care to you.