Governance, Risk & Compliance Manager

Summary

As the Healthcare Compliance Manager, you will serve as a pivotal liaison, ensuring the seamless integration of operations, IT, and compliance within the healthcare space. Your role will be to uphold the highest standards of HIPAA Privacy & Security, facilitate the adoption of innovative AI and automation tools, and guide our teams through the intricate landscape of healthcare regulations.

Key Responsibilities

• Act as the primary contact between operations teams, IT, and the compliance team, promoting adherence to HIPAA, Wipro policies, and Business Associate Agreements.
• Direct compliance training initiatives and refreshers to maintain a high level of regulatory awareness and compliance within operational practices.
• Develop and implement account-specific compliance policies, procedures, and processes that align with state, federal, and client-specific regulatory requirements.
• Spearhead robust processes for the investigation, reporting, and remediation of privacy and security events.
• Ensure the formulation of solid Business Continuity & Disaster Recovery Plans to safeguard Protected Health Information (PHI).
• Conduct thorough privacy & security audits and assist in the remediation of any findings to strengthen the integrity of PHI.Oversee the creation of transparent, accountable, and ethical automation tools and processes, ensuring they adhere to privacy, security, and industry best practices.
• Provide subject matter expertise on CMS regulatory audit & monitoring activities, including data validation, audit responses, and the implementation of Corrective Action Plans.
• Stay abreast of evolving AI regulatory requirements, translating complex regulations into understandable language for cross-functional teams.
• Prepare comprehensive system and process documentation in support of automation initiatives.

Qualifications

Bachelor's Degree required, JD PreferredHealthcare Compliance certification (CHC and CHPC preferred) from Healthcare Compliance Association (HCCA)12+ years of experience in healthcare (payer or provider) operations and/or complianceWorking knowledge of the HIPAA Privacy & Security RulesDemonstrated experience drafting, implementing, and updating operational & compliance policies & proceduresExperience performing in-depth legal research and monitoring the regulatory landscape for emerging trends and proposed regulationsAbility to parse complex regulatory requirements into clear, concise and easily understandable language for use by developers and operations teamsExperience reviewing Business Associate Agreements (BAAs) and operationalizing the requirements contained thereinExperience in operations regulated by the Centers for Medicare and Medicaid Services (CMS). Past participation in CMS data validation activities and/or audits is preferredAdvanced skill in developing complex process flows and system documentation for healthcare operations. At least 6 years' experience in internal audit and 10+ years in information technology, with familiarity in HiTrust, PCI, SOC, and Healthcare IT.In-depth knowledge of IT control frameworks or standards such as CobIT, ISO/IEC 27002, NIST 800-53. Proven track record of managing diverse team requirements with an understanding of compliance management obligations. Proficiency with Microsoft Office Suite, SharePoint, and project management tools.