MLTC-Reg Affairs Associate

 RiverSpring Health Plans serves over 16,000 frail individuals and help them live in their homes and independently for as long as possible.  Join our compassionate and dedicated team and make a difference in the lives of our members at RiverSpring Health Plans.  The Regulatory Affairs Associate will be responsible for the planning, developing, directing, delivering, evaluating, and coordinating activities of the Regulatory Affairs Department.

The Regulatory Affairs Associate will be responsible for handling Regulatory Affairs Department activities, including contracts, compliance, surveys, audits, investigations, provider network and relations, and other regulatory compliance matters. Responsibilities include:

• Review, draft, negotiate and process agreements and amendments in accordance with organization guidelines
• Manage projects involving the collection and submission of data and information related to government audits, surveys and requests
• Handle provider contracting, including letters of agreement; conduct follow-up
• Review, disseminate and handle fair hearing (FH) notices; manage FH calendar; conduct preparations for FHs, attend FHs as needed, review and handle communications and submit reports; prepare status reports and updates on cases
• Handle activities of the Special Investigation Unit (SIU), including SIU reporting and internal investigations
• Update applicable HIPAA policies and procedures in compliance with HIPAA laws and regulations
• Review OIG/OMIG requirements and best practices for compliance program; review and update compliance materials, including manuals, policies and procedures, handbooks, to comply with regulatory requirements; make recommendations based on best practices and draft policies and procedures for approval
• Review DOH and CMS plan contracts, and edit plan documents in compliance with contract requirements
• Review and disseminate CMS memos and DOH guidance; keep abreast of related laws, regulations and official guidance
• Coordinate document and requests of outside counsel for litigation matters
• Maintain databases of provider credentials and other information
• Draft policies, procedures, manuals, plan materials
• Provide oversight and supervision of Department’s staff

JD and minimum 3 years’ experience, with emphasis in managed care contracting, credentialing and compliance. MLTC, MAP and Medicaid/Medicare knowledge required.  Commensurate supervisory experience required. Competence in reviewing legal and commercial terms of agreements. Ability to investigate incidents and recommend solutions. Skilled in organization and management of details. Excellent writing, editing and proofreading skills.

Compensation: $125,000-$150,000 Annually  

Our staff are our greatest asset and as such we offer an excellent and comprehensive benefits package which includes:

HEALTH & INSURANCE BENEFITS*

Medical and Prescription Drug
Company-Paid Dental
Company-Paid Vision
Company-Paid Life Insurance and Accidental Death & Dismemberment
Company-Paid Short-Term Disability
Company-Paid Long-Term Disability
Health Care Flexible Spending Account
Dependent Care Flexible Spending Account
Employee Assistance Plan
Additional Life Insurance options for the employee and family members
Additional Disability options
403(b) Plan, with a generous employer contribution
TIME OFF BENEFITS*
Holidays
Personal Days
Sick Days
Vacation

ADDITIONAL BENEFITS*
Bereavement Days
Cell Phone Discount Plan
Commuter Plan
Jury Duty Days
Marriage Days
Pet Insurance Discount Plan
Tuition Assistance
Wellness Programs
Years of Service Awards

*This information is subject to change and it is not meant to be a comprehensive explanation of our employee benefits. The benefits contained in this benefit summary could change at any time without notice.

EOE