WHAT YOU CAN EXPECT!

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The Analyst II, Regulatory Affairs has experience with and performs key centralized 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, Covered California, 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.

EDUCATION & EXPERIENCE

• Two (2) years of experience with managed care or other relevant industry experience.
• Experience in health care, health plans, Covered California, 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 university required.
• Knowledge of and experience with state and Federal regulatory and other requirements and practices related to Covered California, 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.

KEY QUALIFICATIONS

• Ability to work autonomously.
• Knowledge of Principles and practices of managed care.
• Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access.
• Must have a 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.
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1. Serve as the Plan’s internal subject matter expert by interpreting and applying a broad array of contract, legislative and regulatory requirements that affect multiple departments within the Plan.
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. Disseminate the requirements and analyze the responses. Obtain an understanding of the various systems and data sources utilized by the Plan. Identify risks, issues, barriers with ensuring compliance and recommend solutions to the internal department which includes process and/or operational improvements.
3. Ensure the Plan’s lines of business are in compliance with contract(s) with the CMS, contract(s) with the DHCS, Knox-Keene license(s) with the DMHC, Covered California, and any other applicable regulatory agencies. Develops recommendations for appropriate action to ensure compliance.
4. Review and analyze 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. Advise and collaborate with internal departments to ensure adherence with guidance and recommendations provided. Develops and recommends policies and procedures, standard operating procedures, desk-top procedures where gaps, issues and/or risks are identified.
5. 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, Covered California, and any other applicable regulatory agencies. Responsible for receiving, researching, coordinating, responding timely and tracking all inquiries and submissions to the CMS, the DMHC, Covered California, and the DHCS. Collaborate with internal departments to ensure reporting and submission requirements are applicable to the Plan’s lines of business, captured in the systems appropriately and are reportable. Provide comprehensive data validation of reports prior to submission. Assist internal departments in making operational decisions to ensure compliance with reporting requirements.
6. Analyze and interpret the Knox-Keene Act; identify eFiling and submission requirements. 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. 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.
10. Participate in relevant committees and work groups; develop reports and presentations with recommendations for appropriate action 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. Develop external and internal policies and procedures.
    Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.