Analyst I - Regulatory Affairs (Policy & Communications)

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Manager, Regulatory Affairs, the Analyst I - Regulatory Affairs (Policy & Communications) has a general knowledge of and performs key centralized regulatory activities of moderate difficulty 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), in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

Key Responsibilities

1. Serve as the Plan’s internal Compliance point of contact for Regulatory Affairs matters.
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. Participates in workgroups to assist internal departments in making administrative and operational decisions.    
3. Monitors the Plan’s lines of business adherence to contract(s) with the CMS, contract(s) with the DHCS, Knox-Keene license(s) with the DMHC, and any other applicable regulatory agencies.
4. Triage 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.
5.  May assist in ensuring compliance with the Plan’s lines of business reporting and submission requirements to the CMS, the DHCS, the DMHC, and any other applicable regulatory agencies. May be responsible for receiving, researching, coordinating, responding timely and tracking all inquiries and submissions to the CMS, the DHCS, the DMHC, and any other applicable regulatory agencies.
6. 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. May support other components of the Plan’s compliance program, such as Privacy, Data Security, Code of Business Conduct and Ethics, Fraud Waste & Abuse, etc.
10. Attend relevant committees and work groups; may develop reports and presentations 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. Assist with the maintenance of external and internal policies and procedures.

Education & Experience

• One (1) year  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
• Bachelor’s degree from an accredited institution required

Key Qualifications

• Valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
• 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
• Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access 

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