Analyst III - Regulatory Affairs

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 III – Regulatory Affairs has expert knowledge of and performs key centralized overly 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, 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).

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.

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

1.  Leads the development and implementation of organization-wide project initiatives for the Compliance Department; including but not limited to, technical/analytical support, creation of project timelines, identification of project deliverables, and oversight of the overall status of the project.
2. Effectively manage multiple projects concurrently. Effectively communicate the status of assigned projects to Executive Leadership including risks, issues, barriers identified and recommended solutions.
3.  Communicates new and revised laws and regulatory guidance that affect the Plan and interpret/summarize the requirements. Disseminate the requirements and analyze the responses. Obtain an understanding of the various systems and data sources utilized by the Plan. Develop tools, templates and resources to identify risks, issues, and barriers.  Leads workgroups to ensure compliance and recommended solutions are included in the process and/or operations improvements implemented by the impacted internal department
4.  Lead workgroups to ensure compliance with the Plan’s lines of business(es) are in compliance with contract(s) with the CMS, contract(s) with DHCS, Knox-Keene license(s) with the DMHC and any other applicable regulatory agency. Perform complex analysis to identify risks and issues and recommend solutions.      
5.  Triage complex compliance issues and inquiries from internal departments, understand the underlying intent of the questions, and perform necessary research and analysis to provide accurate responses and recommendations. Lead workgroups to ensure adherence with the guidance and recommendations provided.
6.  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 and any other applicable regulatory agencies.  Responsible for receiving, researching, coordinating, responding timely and tracking all inquiries and submissions to the CMS, the DHCS, and the DMHC. Collaborate with internal departments to ensure reporting and submission requirements are applicable to the Plan, captured in systems appropriately and are reportable. Provide comprehensive data validation of reports prior to submission. 
7.  Prepare 1352(a) Amendments and Material Modifications for submission to the DMHC.  Receive, coordinate and respond timely to all subsequent Comment Letters and amendments. 
8.  Report potential risks, non-compliance or alleged violations to the Director of Compliance.
9.  Under the direction of the Manager, Regulatory Affairs assist in preparing the Plan for regulatory audits.
10.  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.
11.  Lead and/or participate in relevant committees and work groups; make presentations, prepare reports, data or other materials for committee presentation.
12.  Proactively identify areas of improvement for the Compliance Department and participate in development of performance improvement initiatives.
13.  Assist with the maintenance of external and internal policies and procedures.

Education & Experience

• Four (4) or more years of experience with managed care or other relevant 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. 
• 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.
• Bachelor's degree from an accredited institution required.

Key Qualifications

• Possess strong interpersonal and presentation skills to communicate with internal departments and external agencies
• Effective communication skills; verbal and written
• Strong organizational skills and attention to detail
• Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access 

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA)