Senior Director, Compliance and Privacy
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Job Description
Senior Director leading healthcare compliance, regulatory auditing, and HIPAA privacy programs for American Health Plans. Overseeing risk assessments, investigations, training, audits, and regulatory readiness.
Responsibilities:
- Lead, develop, and manage the organization’s compliance program in alignment with federal and state regulations and industry best practices
- Supervise and mentor compliance staff
- Design and oversee internal auditing, monitoring, and enterprise-wide risk assessment programs
- Identify vulnerabilities and implement mitigation strategies
- Oversee incident reporting, compliance investigations, corrective actions, and resolution
- Coordinate external audits, regulatory reviews, site visits, inquiries, readiness activities, and corrective action plans
- Oversee compliance committee activities and present updates to leadership and stakeholders
- Develop, implement, and maintain compliance policies, procedures, and standards of conduct
- Design and deliver compliance training and promote compliance and ethical awareness
- Monitor regulatory changes and evaluate operational impacts, including Medicare Advantage, Prescription Drug, 340B, HIPAA, Medicare, Fraud Waste and Abuse, OIG, state HMO, clinical documentation, quality, and patient safety requirements
- Serve as HIPAA Privacy Officer and coordinate privacy and security compliance oversight
- Oversee privacy incident responses, investigations, breach notification and reporting, HIPAA risk assessments, and mitigation activities
- Perform other duties as assigned
Requirements:
- Strong project management and organizational skills
- Ability to manage multiple priorities and deadlines
- Excellent written, verbal, and presentation skills
- Ability to interpret and communicate complex regulatory requirements clearly and practically
- Strong interpersonal skills and ability to build collaborative relationships across organizational levels
- Proficiency with Microsoft Office applications, compliance management systems, and incident reporting platforms
- Ability to analyze data, prepare reports, and monitor compliance metrics and key performance indicators
- Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, Health Information Management, Law, or a related field required
- Minimum of three (3) years of progressively responsible experience in healthcare compliance, privacy, risk management, auditing, legal/regulatory affairs, or related healthcare operations
- Minimum of three (3) years of leadership or management experience overseeing compliance and/or privacy programs
- Relevant professional certification, such as CHC, CCEP, or Certified in Healthcare Privacy Compliance
- Proficiency with HIPAA, Medicare Advantage, Prescription Drug Program, 340B, Medicare, Fraud Waste and Abuse, OIG, and state HMO compliance requirements
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