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Compliance & Regulatory WellCare - Regulatory Careers

Medicare Regulatory Specialist Job

Full Job Title: Medicare Regulatory Specialist

Job Number: 1801868

Location: Tampa, FL

Date Posted: 3-21-2018

Supports the Medicare Regulatory team in the management of our contracts with the Centers for Medicare and Medicaid Services and regulatory requirements associated with the Medicare lines of business. In addition, may also support the specialty products and expansion projects.

Essential Functions:

  • Partner with business areas to help ensure processes are implemented to comply with CMS regulatory and contractual requirements.
  • Provide regulatory support and advice to business owners as new regulations emerge (e.g., updated versions of the Medicare Managed Care Manuals).
  • Develop regulatory subject matter expertise on specific functions.
  • Dissemination of HPMS notices and appropriate follow up.
  • Supports regulatory analysis, including the review, summarization and dissemination of key regulatory updates and changes.
  • Supports development of regulatory process flows.
  • Supports design, development and implementation of the Regulatory database ensuring all key departmental processes are captured in the database for tracking and trending purposes.
  • Supports management of the regulatory communications process ensuring all regulatory communications/updates are received, summarized, catalogued, disseminated and acted upon.
  • Coordinates filing of regulatory forms, reports, etc and assists other departments in understanding and complying with regulatory requirements and data entry of submission and preparation of regulatory forms and reports.
  • Tracks all issues referred to the Regulatory Affairs Department up to and including resolution.
  • Represents the health plan at federal, state, and local government meetings.
  • Performs other duties as assigned.

Additional Responsibilities:

Candidate Education:
  • Required A Bachelor's Degree in a related field
Candidate Experience:
  • Required 3 years of experience in preferably in a managed care/health insurance/public health/health care administration/PFFS/Medicare Part D or related field.
  • Preferred Other Previous State or Federal managed care compliance.
  • Required Other Experience in reading, analyzing and interpreting State and Federal laws, rules and regulations.
  • Required Other Specialty products experience may be required based on the position.
Candidate Skills:
  • Intermediate Knowledge of community, state and federal laws and resources
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to work independently
  • Intermediate Demonstrated analytical skills
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Ability to multi-task
  • Intermediate Ability to work within tight timeframes and meet strict deadlines
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Other an understanding of operational processes and regulatory requirements
  • Intermediate Other Demonstrates self-motivation, initiative, practical learning skills, enthusiasm and an ability to complete multiple tasks in a timely and accurate manner
  • Intermediate Other Experience in reading, analyzing and interpreting State and Federal laws, rules and regulations
  • Intermediate Other Ability to develop partnerships, and good working relationships
  • Intermediate Other Experience in reading, analyzing and interpreting State and Federal laws, rules and regulations
Licenses and Certifications:Technical Skills:Languages:

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Last Updated On: 12/9/2015