Participates in the oversight of health plan business. Review, analyze and collaborate on implementation of new regulatory requirements or health plan policy. Supports efforts to ensure compliance with the laws, regulations, and policies that govern its Medicare and Medicaid business.
REPORTS TO: DIRECTOR, REGULATORY AFFAIRS
DEPARTMENT: KENTUCKY LEGAL AFFAIRS STATE
POSITION LOCATION: LOUISVILLE, KY 40223
- Supports Regulatory Affairs department with regulatory analysis, including the review, summarization and dissemination of key regulatory updates and changes.
- Conducts independent research on assigned projects, collaborates and coordinates with other departments on information needs to ensure process improvement.
- Partner with compliance department to monitor and track all issues up to and including resolution.
- Communicates directly with regulators to resolve health plan complaints.
- Draft responses to queries by regulatory agencies.
- Supports and/or represents health plan at Fair Hearings or other administrative law activities.
- Represents the health plan at federal, state, and local government meetings, workgroups and seminars.
- Coordinates site visits by Federal and State regulators. This function involves developing work plans, collecting deliverables, mock interviews, and site visit facilitation.
- Supports the management of the regulatory communications process.
- Ensure all regulatory communications/updates are received, summarized, catalogued and disseminated.
- Collaborates with appropriate department leaders to implement new Federal or State health care policies.
- Develops and maintain productive relationships with all levels of management as well as regulators and other relevant external parties.
- Performs other projects as assigned.
- Facilitates and coordinates market review and state approval for all provider and member materials.
- Supports the design and implementation of databases to ensure key departmental processes are documented and tracked.
- High School or GED is required
- Bachelor's Degree in a related field is preferred
- 3 years of experience in a regulatory affairs/ compliance environment or related experience is preferred
- Previous State or Federal managed care compliance experience is preferred
- Ability to work independently
- Ability to work as part of a team
- Ability to work in a matrix environment
- Ability to effectively present information and respond to questions from peers and management
- Knowledge of community, state and federal laws and resources
- Demonstrated project management skills
- Ability to exercise good judgment under pressure
- Ability to manage a diverse and demanding workload
- Familiarity with Medicare and Medicaid programs
- Microsoft Word is required
- Microsoft Excel is required
- Microsoft PowerPoint is required
- Microsoft Outlook is required
- Intermediate Microsoft Project is required *LI-RG1