Job Requisition ID: 5003 Position Summary/Position Under the direction of the Manager, Regulatory Affairs, the Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department. Team Members in this position ensure Plan operations, processes, procedures, policies, etc. are in compliance with regulatory agencies, including but not limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health Care (DMHC). Major Functions (Duties and Responsibilities) 1. Serve as the Plans internal subject matter expert by interpreting and applying a broad array of contract, legislative and regulatory requirements that affect multiple departments within the Plan. 2. Communicate new and revised laws and regulatory guidance that affect the Plan and interpret/summarize the requirements. Disseminate the requirements and analyze the responses. Disseminate the requirements and analyze the responses. Obtain an understanding of the various systems and data sources utilized by the Plan. Identify risks, issues, barriers with ensuring compliance and recommend solutions to the internal department which includes process and/or operational improvements. 3. Ensure the Plans lines of business are in compliance with contract(s) with the CMS, contract(s) with the DHCS, Knox-Keene license(s) with the DMHC, and any other applicable regulatory agencies. Develops recommendations for appropriate action to ensure compliance. 4. Review and analyze compliance issues and inquiries from internal departments and applicable regulatory agencies, understand the underlying intent of the questions, and perform necessary research and analysis to provide accurate responses and recommendations. Advise and collaborate with internal departments to ensure adherence with guidance and recommendations provided. Develops and recommends policies and procedures, standard operating procedures, desk-top procedures where gaps, issues and/or risks are identified. 5. Collaborate with internal departments to ensure compliance with the Plans lines of business reporting and submission requirements to the CMS, the DHCS, the DMHC and any other applicable regulatory agencies. Responsible for receiving, researching, coordinating, responding timely and tracking all inquiries and submissions to the CMS, the DMHC, and the DHCS. Collaborate with internal departments to ensure reporting and submission requirements are applicable to the Plans lines of business, captured in the systems appropriately and are reportable. Provide comprehensive data validation of reports prior to submission. Assist internal departments in making operational decisions to ensure compliance with reporting requirements. 6. Analyze and interpret the Knox-Keene Act; identify eFiling and submission requirements. Prepare 1352(a) Amendments and Material Modifications for submission to the DMHC. Receive, coordinate and respond timely to all subsequent Comment Letters and amendments. 7. Report potential risks, non-compliance or alleged violations to the Director of Compliance. 8. Under the direction of the Manager, Regulatory Affairs assist in preparing the Plan for regulatory audits. 9. Participate in and support other components of the Plans compliance program, such as Privacy, Data Security, Code of Business Conduct and Ethics, Fraud Waste & Abuse, etc. 10. Participate in relevant committees and work groups; develop reports and presentations with recommendations for appropriate action based on the analysis of collected data. 11. Proactively identify areas of improvement for the Compliance Department and participate in development of performance improvement initiatives. 12. Develop external and internal policies and procedures. Supervisory Responsibilities Leading: Self Experience Qualifications 2 - 4 years of experience with managed care or other relevant industry experience. Experience in health care, health plans, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect. Experience interacting with regulatory agencies. Preferred Experience Education Qualifications Bachelors degree from an accredited institution required. Preferred Education Professional Certification Professional Licenses Drivers License Required Yes, must have a valid California Driver's License. Knowledge Requirement Knowledge of Principles and practices of managed care. Knowledge of and experience with state and Federal regulatory and other requirements and practices related to Medicare and Medi-Cal (Medicaid), Title 19 (USC)/Title 29 (USC and CCR), Title 22 (CCR), Title 28 (CCR), Title 42 (USC and CFR), CA Welfare and Institutions Code, and CA Health and Safety Code. Skills Requirement Possess strong interpersonal and presentation skills to communicate with internal departments and external agencies. Clearly and effectively convey project objectives.Strong organizational skills and attention to detail. Effective communication skills; verbal and written.Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access. Abilities Requirement Ability to apply knowledge and address situations appropriately without extensive guidance. Demonstrated ability to establish relationships of trust and respect with Team Members at all levels. Ability to work independently and collaboratively within a team environment. Ability to manage multiple projects with competing deadlines and changing priorities. Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Minimal travel within California. Minimal physical activity; may include standing and repetitive motion. Physical Requirements Starting Salary: $66,040.00 - $84,219.20 Pay rate will commensurate with experience Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, were ready to make a difference today and in the years to come. Join our Team and Make a Difference with us IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.
Inland Empire Health Plans