What You Will Do 

• Counsels on a range of healthcare and privacy legal issues affecting the operations of VNS Health including but not limited to HIPAA, HITECH, 42 CFR Part 2, the Social Security Act, Medicare and Medicaid regulations, the False Claims Act, the Anti-Kickback Statute, and state laws governing the operation of Article 44 health insurers and the delivery of home health care, hospice care, mental health care, substance use disorder treatment, and care management services.
• Assures compliance by analyzing legal issues and drafting internal memos, policy documents, opinions, and other key documents that clearly summarize legal rules, risks, and related recommendations.
• Reviews and evaluates new regulations and related operational practices; Recommends updates to VNS Health policies and procedures as necessary and appropriate.
• Collaborates with cross-functional teams, including Operations, Quality, IT, Compliance, Government Affairs, and Risk, to ensure healthcare and privacy regulatory requirements are met.
• Advises VNS Health leadership, management, and staff on sub-regulatory agency guidance including model contracts, consents, authorizations, and other government forms applicable to health plans, insurance products, and health care provider services.
• Serves as a healthcare and privacy regulatory subject-matter expert and supports other members of the CLRO with regulatory matters.
• Advises on permissible data sharing between and among VNS Health affiliates and/or external entities.
• Directs privacy and security investigations, as needed, and remediation of security incidents.
• Conducts privacy risk assessments and audits and develops strategies to mitigate identified risks.
• Represents VNS Health in interactions with regulatory agencies and external stakeholders.
• Provides training and education to employees on privacy and regulatory compliance matters.
• Counsels staff on regulatory matters related to member enrollment, patient admission and discharge, and difficult-to-serve patients/members; Works with staff and outside counsel with respect to regulations governing fair hearings, care coordination, service delivery, and termination of enrollment.
• Counsels staff on regulatory matters related to member enrollment, patient admission and discharge, and difficult-to-serve patients/members; Works with staff and outside counsel with respect to regulations governing fair hearings, care coordination, service delivery, and termination of enrollment.
• Participates in special projects and performs other duties as assigned.