Analyst I
4 weeks ago
What you can expect
Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience
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), in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.
Key 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.
Additional Benefits:
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Qualifications:
Education & Experience
One (1) year 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
Bachelor’s degree from an accredited institution required
Key Qualifications
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
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
Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access
Work Model Location:
The work location for this position is classified as “hybrid”. Onsite attendance in Rancho Cucamonga, CA is required on Tuesday, Wednesday, and Thursday of every week. Telecommute days are Monday and Friday.
Start your journey towards a thriving future with IEHP and apply TODAY
Pay Range:
USD $30.72 - USD $39.94 /Hr.
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