The Regulatory Analyst is an integral position within the Plan. This position is responsible for the compliance of the Plan contract with CMS and the State (covering the SNP and/or MMP plan). The position is responsible to ensure compliance with federal, state and local laws, regulations and policies, mitigate potential liabilities and help to avoid penalties, sanctions or other legal punishment. The position is responsible for Medicare communications, researching and interpreting regulations, and working with the operational and functional areas to ensure integration of the requirements.
Essential Duties and Responsibilities include the following:
- Work with management to clearly articulate regulatory guidance, identify risk and drive mitigation.
- Disseminate guidance to appropriate operational areas to include, deliverables to confirm compliance.
- Oversee the development and monitoring of corrective action plans coordinate validation of any corrective actions to ensure remediation is completed;
- Oversee and administer ongoing monitoring program(s) based on guidance
- Updates policies and procedures as needed
- Adhere to established corporate policies and procedures
- Perform other duties, as necessary, to meet corporate objectives
- Travel as required
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
- Bachelor’s degree in Health Care or other related field
- Solid experience in managed care with a minimum of five (5) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.)
- Knowledge of federal healthcare laws, regulations and guidance.
- Solid knowledge of CMS, Medicare Part C and Part D regulations.
- Ability to work independently, manage multiple projects and meet scheduled deadlines.
- Ability to identify root cause issues and ensure appropriate corrective actions.
- Strong analytical and organizational skills with attention to detail.
- Proficiency in applying and interpreting rules associated with Medicare regulations.
- Excellent written and verbal communication skills required
- Advanced degree or certification in law or compliance discipline preferred
- Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.