POSITION SUMMARY
Directs the legal affairs and risk management areas of the organization. Provides legal counsel and support to all departments of the company to resolve various issues of a legal and compliance nature including, but not limited to regulatory and statutory compliance matters, insurance regulations, other corporate governance, privacy, and related health care laws or government programs - Medicare and Medicaid. Ensures maximum protection of the organization's legal rights, utilizing broad familiarity with most major legal disciplines including: business transactions, corporate governance, employment and labor, health care and insurance, licensing and regulatory compliance, intellectual property and technology, risk management, and litigation management. Directs the defense of the organization against suits or claims and prepares the prosecution of the organization's claims against others. Oversees the legal aspects of organization transactions and the preparation of reports and statements of a legal nature. As a member of the management team, this position is actively involved in company operations, and supports the strategic objectives of HDS. Also functions in similar capacity for Hawaii Client Services (HCS).
ESSENTIAL DUTIES AND RESPONSIBILITIES
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Effectiveness/Efficiencies– Develops, implements, evaluates, and recommends best practices to ensure effective work processes and systems, maximize operating efficiencies and increase the value of services provided in alignment with department and company goals and objectives.
- Directs and manages outside counsel/litigation resources as necessary. Assists with resolving legal-related disputes.
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Researches, reviews, analyzes, interprets, drafts, negotiates, approves, and/or directs the processing of various complex legal and compliance documents, including but not limited to legal opinions and associated analyses; existing and proposed legislation; contracts and other agreements; regulatory filings and other regulatory documents; company licensing and registration; certain department or company policies and procedures; materials relating to employer groups, subscribers, providers, and other third parties; court or agency orders; communications; or other documents.
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Researches and performs detailed analysis of legal and compliance matters, including interpreting and advising regarding current and proposed laws and regulations to determine impacts to organization.
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Reviews, interprets, drafts, and negotiates contracts, including but not limited to business associate agreements, administrative service agreements, service agreements with vendors, software licensing agreements, and other general commercial business transactions.
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Researches, provides legal opinions, and drafts documents relative to regulatory filings with respect to policy forms, rates, agent and entity licensing and maintenance, consumer inquiries, and advertising materials and assists with and/or monitors the development and compliance of insurance forms, including but not limited to policies, contracts, summary plan descriptions, certificates of benefits and other product related documents and ensures governmental and regulatory approval in the appropriate jurisdiction.
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Prepares corporate documents as necessary.
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Internal Controls/Compliance– Develops, implements, evaluates, and recommends controls to satisfy operational/compliance risk requirements, ensure data integrity, and best practices. Keeps abreast of current regulations and compliance issues that may impact the department and company.
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Directs the Legislative Agenda and serves as the primary liaison. Monitors legislation; tracks government issues that could affect the company. Proactively researches policies and trends that might impact the company in the future.
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Maintains a working knowledge of relevant issues, laws, regulations, and requirements related to the compliance program, including but not limited to regulations and guidance under HIPAA, Medicare and Medicaid programs, and other insurance programs.
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Participates in establishing and providing compliance education, training, and awareness programs for employees, providers, and contractors.
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Facilitates, coordinates, and cooperates with auditing activities by outside agencies and internal departments that affect the corporate compliance program.
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Investigates, tracks, and makes recommendations regarding inquiries or complaints received from external regulatory agencies. Prepares responses to subscriber and provider complaints filed with the state insurance departments and other regulatory and administrative agencies, as well as responds to subpoenas and other document requests.
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Assists with implementing regulatory, legislative, and contractual requirements. This specifically includes developing, initiating, maintaining, and revising policies, procedures, and reporting for the general operation of the legal department and its related activities.
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Develops, maintains, and updates legal systems and records. Responsible for assisting with HDS Board-related activities, including but not limited to corporate governance, maintaining corporate records, and preparing for, attending, and taking board minutes at meetings as needed. Completes the corporate and regulatory filings, renewals, and reports.
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Manages and oversees the various programs that fall under the legal affairs and enterprise risk management areas, including but not limited to Audits (SOC 1 and 2, DDPA, Groups, EUTF, etc.), Insurance Renewals, Contract/Vendor Management, and Policies & Procedures Management.
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Management and Supervision
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Supervisory
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Supervises/Manages the following staff: Direct Reports: 1 Paralegal/Risk Management Analyst. Manages, plans, organizes, supervises, trains, motivates, and evaluates staff; including making final hiring & termination decisions, assigning work, developing growth opportunities, conducting performance evaluations, and taking corrective action. Communicates and assures that employees have a clear understanding of performance expectations and responsibilities. Plans, directs, and manages toward effective and appropriate activities and ensures satisfactory performance of those employees.
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Budget
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Develops and manages annual budget in alignment with company goals and objectives.
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Business Plan/Establish Departmental Goals
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Develops long and short-term strategic plans concerning the successful operation of the Legal department.
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Develops, implements, evaluates, and effectively communicates goals and responsibilities in alignment with company-wide objectives and goals.
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Contributes to the Executive’s development of company goals and standards, and monitors and reports selected company goals and standards.
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Policies/Procedures
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Develops, implements, and enforces departmental policies and procedures. Ensures initial and recurrent training occurs.
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Manages, implements, and enforces the HDS Records Retention Program.
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Other Duties and Responsibilities
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Customer Service (Internal/External)
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Plans, directs, and manages the activities related to the department. Monitors productivity and performance while ensuring professionalism, quality, timeliness, and accuracy in accordance with overall company-wide objectives to ensure positive working relationships with internal and external customers.
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Functions as a legal liaison for outside counsel, DDPA, and federal and state law enforcement.
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Functions as a compliance and internal audit liaison for outside counsel, DDPA, federal and state law enforcement, and external auditors.
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Performs other related duties as required or assigned by the President & CEO.
MINIMUM QUALIFICATIONS AND EXPERIENCE
Education
Juris Doctorate from an accredited law school. Hawaii State Bar admission required. If relocating, Hawaii State Bar admission is required within two years of employment date.
Experience
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Minimum of ten (10) years of legal experience, including five (5) years of experience as in-house counsel.
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Minimum of two (2) years of experience managing staff.
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Experience with Healthcare laws and regulations including, Medicaid, Medicare, and HIPAA, and Hawaii laws and regulations, is preferred.
Skills and Knowledge
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Ability to handle confidential and sensitive issues and materials.
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Ability to assess, develop, and implement programs, policies, and procedures.
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Detail-oriented with strong analytical, research, problem-solving and reasoning skills.
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Excellent organizational skills and ability to handle multiple tasks.
Note: The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.
