Compliance and Privacy Business Partner

About the role

The Compliance Business and Privacy Partner (CBPP) aligns business objectives by providing regulatory support, compliance, and privacy oversight for designated departments. This role partners with staff and leadership to identify compliance risks, oversee corrections, and provide regulatory interpretation. The Business Partner assesses and anticipates compliance-related needs, communicates proactively with management, and develops integrated solutions to mitigate risk. Using risk assessments, monitoring, and auditing results, this position ensures compliance with policies, procedures, federal and state contracts, and laws and regulations.

Responsibilities

• Assists the Compliance and Privacy Officer with identification, oversight, ongoing monitoring, and corrective action for all compliance and privacy-related items.
• Monitors business area processes and procedures against all applicable compliance and privacy requirements.
• Participates in scheduled Compliance Committee meetings with respective business units.
• Provides interpretation of new, changed, or existing regulatory and contractual requirements and assesses potential impacts.
• Performs formal and informal risk assessments to identify compliance risks.
• Establishes, builds, and fosters relationships with assigned departments and all levels of the organization.
• Develops, tracks, and monitors internal audit corrective action plans to ensure full implementation.
• Follows up, verifies, and evaluates the adequacy of post-audit corrective actions.
• Collaborates with operational areas to develop and implement an internal regulatory compliance framework.
• Complies with guidelines established by CMS, EOHHS, OHIC, and other regulatory agencies.
• Maintains in-depth knowledge of regulatory, subregulatory, and other applicable requirements related to compliance and privacy.
• Partners with the legal department as needed.
• Identifies compliance and privacy training needs for the organization and business units.
• Participates in department continuous quality improvement activities.
• Takes responsibility for professional development and supports a learning environment.
• Other duties as assigned.

Requirements

• Bachelor’s Degree in healthcare or a related discipline, or sufficient experience/background to equate to the degree.
• Minimum of four (4) years of experience working in a healthcare environment, with at least one (1) year in a regulatory environment.
• Ability to think analytically, communicate complex issues, and develop control recommendations.
• Project management experience.
• Effective written and verbal communication skills, with the ability to present analysis and recommendations clearly and professionally.
• Strong interpersonal skills and customer service orientation.
• Proven organizational skills and attention to detail.
• Ability to maintain confidentiality.
• Ability to prioritize tasks effectively and work independently.

Qualifications

• Preferred:
• Detailed knowledge of government healthcare program regulations, including contract interpretation.
• Working knowledge of CMS, EOHHS, and OHIC rules and regulations, and familiarity with compliance tools (e.g., OMT/Gorman Tool).
• Two (2) to four (4) years of experience in health insurance compliance, including Medicare or Medicaid compliance.