Healthcare Exchange: Director Of Data Science

About Penstock Regulatory Solutions

Penstock Regulatory Solutions provides customized filing solutions that caters to Health Plans of all sizes. Have you ever wanted to be part of a fast paced new and exciting, growing team? Now is your chance! We equip all of our agents with the tools and resources to make Affordable Healthcare easier to understand while increasing speed to market, reducing waste, and always providing continuous improvement opportunities for our Health Plan Clients. We guide our Plan partners to be nothing but successful in serving members who need greater access to care through Qualified Health Plans.

Job Description Summary

The Healthcare Exchange Director is responsible for driving forward a number of exciting activities:

• Serves as the primary market development professional supported by Product Management Team Leadership, inclusive of the Product Director, and Vice President
• Keeps abreast of current / emerging national and regional industry and competitor trends, inclusive of plan design reviews, regional and national shifts, and emerging political and PHE impacts to Health Plan Carriers (winding, and unwinding) of both Federal and State dictation of plan management functions.
• Strong writing, research, and communications capabilities both internally and externally
• Typically leads new market research and on-the-ground stakeholder engagement, not limited to completing build versus buy analysis as needed, sourcing vendor partnerships for billing, enrollment, and pricing analysis to ensure functional capabilities are available within the marketplace.
• Works in conjunction with Government Relations (internal/external) to develop new market relationships with legislators and government regulators, and health plan associations such as ACAP, MAHP, and others.
• Develops and leads stakeholder engagement strategy and coordinates support from Product Management Team and other internal stakeholders as necessary.
• Develops and leads RFP and Business Development Pipeline process.
• Support the development and on-going delivery of product line specific dashboards.
• Leading the Qualified health plan (QHP) submission effort for the enterprise for all markets and service territories within your designated region (e.g. Northeast, Southeast, Middle America)

• Understanding, socializing, and complying with multiple state-specific and federal guidelines and filing deadlines throughout the year.

• Coordinating Annual QHP filing and certification process for current/future exchange markets

• Facilitating the QHP and certification process with business function stakeholders, Health Plan Partners and subject matter experts to obtain all required information to complete the filing, and other related deliverables, and submit the file according to applicable state and federal guidelines on the appropriate platforms (e.g., HIOS, SERFF).  

• Supporting the President of Regulatory Solutions with the ACA product portfolio lifecycle and preparing necessary data and analyses during the product life cycle.  

• Receiving, logging, assigning, tracking, and reporting status for feedback and objections from the states and federal government through completion.  

• Reporting on a regular basis to the stakeholders and department leadership the status of all submissions to the various states and the federal government
• Address and build out opportunities for open AI (Artificial Intelligence)
• Address and build out opportunities for open Source Coding
• Address and build out Algorithms to streamline service and software solutions 

Additional Key Functions and Responsibilities

• Ensure that all assigned projects are delivered on-time within scope and budget
• Assist in the definition of project scope and objectives, involving all relevant stakeholders and ensuring technical feasibility
• Develop a detailed project plan to monitor and track progress
• Manage changes to the project scope, project schedule and project costs using appropriate verification techniques
• Measure project performance using appropriate tools and techniques
• Report and escalate to Penstock Leadership as needed
• Manage cross-functional relationships and coordinate internal resources and third parties/vendors for the flawless execution of projects
• Ensure resource availability and allocation
• Perform risk management to minimize project risks
• Create and maintain comprehensive project documentation including post-project SOPs and project artifacts
  

Education and Experience

• Bachelor's degree or related Product/Project Management Certificate (PMP/CPM)

• Preferred Health Insurance background/knowledge of Qualified Health Plans

• Preferred experience with government insurance programs and tools related to filing or ability to find and utilize online resources. Training is provided for the right candidate

 
Tools

• Proficiency in Microsoft Office Word, Excel, Outlook, PowerPoint, SharePoint and Visio. 

• Preferred Experience with Regulatory Portals
  • SERFF (Systems for Electronic Rate/Form Filing)
  • HIOS (Health Insurance Oversight System)
  • REGTAP (Registration for Technical Assistance Portal)
  • RBIS (Rate and Benefit Information System)