Analyst III - Regulatory Affairs - Medi-Cal (Hybrid Work Schedule)

Position Summary/Position

Under the direction of the Manager, Regulatory Affairs, the  Analyst III – Regulatory Affairs has expert knowledge of and performs key centralized overly 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.  Leads the development and implementation of organization-wide project initiatives for the Compliance Department; including but not limited to, technical/analytical support, creation of project timelines, identification of project deliverables, and oversight of the overall status of the project.
2.  Effectively manage multiple projects concurrently.  Effectively communicate the status of assigned projects to Executive  Leadership including risks, issues, barriers identified and recommended solutions.
3.  Communicates new and revised laws and regulatory guidance that affect the Plan and interpret/summarize the requirements.  Disseminate the requirements and analyze the responses.  Obtain an understanding of the various systems and data sources utilized by the Plan.  Develop tools, templates and resources to identify  risks, issues, and barriers.  Leads workgroups to ensure compliance and recommended solutions are included in the process and/or operations improvements implemented by the impacted internal department
4.  Lead workgroups to ensure compliance with the Plan’s lines of business(es) are in compliance with contract(s) with the CMS, contract(s) with DHCS, Knox-Keene license(s) with the DMHC and any other applicable regulatory agency. Perform complex analysis to identify risks and issues and recommend solutions.      
5.  Triage complex compliance issues and inquiries from internal departments, understand the underlying intent of the questions, and perform necessary research and analysis to provide accurate responses and recommendations.  Lead workgroups to ensure adherence with the guidance and recommendations provided.
6.  Collaborate with internal departments to ensure 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.  Responsible for receiving, researching, coordinating, responding timely and tracking all inquiries and submissions to the CMS, the DHCS, and the DMHC.  Collaborate with internal departments to ensure reporting and submission requirements are applicable to the Plan, captured in systems appropriately and are reportable. Provide comprehensive data validation of reports prior to submission. 
7.  Prepare 1352(a) Amendments and Material Modifications for submission to the DMHC.  Receive, coordinate and respond timely to all subsequent Comment Letters and amendments. 
8.  Report potential risks, non-compliance or alleged violations to the Director of Compliance.
9.  Under the direction of the Manager, Regulatory Affairs assist in preparing the Plan for regulatory audits..
10.  Participate in and support other components of the Plan’s compliance program, such as Privacy, Data Security, Code of Business Conduct and Ethics, Fraud Waste & Abuse, etc.
11.  Lead and/or participate in relevant committees and work groups; make presentations, prepare reports, data or other materials for committee presentation.
12.  Proactively identify areas of improvement for the Compliance Department and participate in development of performance improvement initiatives.
13.  Assist with the maintenance of external and internal policies and procedures.

Supervisory Responsibilities

Experience Qualifications

4 or more years of experience with managed care or other relevant 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.

Education Qualifications

Bachelor's degree from an accredited institution required.

Drivers License Required

Knowledge Requirement

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. Principles and practices of managed care.

Skills Requirement

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

Abilities Requirement

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.  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.