Analyst I - Regulatory Affairs

Date: Aug 30, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5651 

 

Position Summary/Position

 

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).     

Major Functions (Duties and 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.

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

1 - 3 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

 

Bachelor’s 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

 

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

 

Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access. Effective communication skills; verbal and written. Possess interpersonal and presentation skills to communicate with internal departments and external agencies. Strong organizational skills.

Abilities Requirement

 

Ability to manage multiple projects with competing deadlines and changing priorities. Clearly and effectively convey project objectives.  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. Attention to detail.

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

 

Possession of a valid California Drivers License and automobile insurance required.

Minimal travel within California.  Minimal physical activity; may include standing and repetitive motion.

Physical Requirements

 

Starting Salary: $57,948.80  - $73,860.80  

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, we’re 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.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles