Analyst II - Regulatory Affairs (hybrid)

Inland Empire Health Plan•Rancho Cucamonga, CA

4d•$71,573 - $93,038•Hybrid

About The Position

The Analyst II, Regulatory Affairs performs complex regulatory activities for the Compliance Department under the direction of the Manager, Regulatory Affairs. The role helps ensure that the Plan’s operations, processes, procedures, and policies comply with requirements from agencies including Covered California, CMS, DHCS, and DMHC. The analyst interprets regulatory and contractual requirements, communicates new or revised guidance, identifies compliance risks, and recommends actions and operational improvements. The position coordinates regulatory inquiries and submissions, supports reporting and data validation, prepares DMHC filings, and assists internal departments with compliance decisions. It also supports regulatory audits and other components of the Plan’s compliance program, participates in committees and work groups, and develops policies, procedures, reports, and recommendations. The role is hybrid: remote on Monday and Friday, and onsite Tuesday through Thursday in Rancho Cucamonga, California. Minimal travel within California may be required.

Requirements

Two years of experience with managed care or other relevant industry experience.
Experience in health care, health plans, Covered California, Medicaid Managed Care Plans, Medicare Advantage, Medicare Part D, Special Needs Plans, and/or Medicare-Medicaid Plans/Cal MediConnect.
Experience interacting with regulatory agencies.
Knowledge of and experience with state and federal requirements and practices related to Covered California, Medicare and Medi-Cal (Medicaid), Title 19 (USC)/Title 29 (USC and CCR), Title 22 (CCR), Title 28 (CCR), Title 42 (USC and CFR), the California Welfare and Institutions Code, and the California Health and Safety Code.
Bachelor’s degree from an accredited institution.
Valid California driver’s license and valid automobile insurance; must qualify for and maintain a driving record that meets IEHP vehicle insurance standards, with no more than three points.
Knowledge of the principles and practices of managed care.
Strong interpersonal and presentation skills for communicating with internal departments and external agencies.
Ability to clearly and effectively convey project objectives.
Strong organizational skills and attention to detail.
Effective verbal and written communication skills.
Proficiency with Microsoft Office programs, including Word, Excel, PowerPoint, Outlook, and Access.
Ability to apply knowledge and address situations appropriately without extensive guidance.
Ability to build relationships of trust and respect with team members at all levels.
Ability to manage multiple projects with competing deadlines and changing priorities.
Ability to work independently and collaboratively within a team environment.

Responsibilities

Interpret and apply contract, legislative, and regulatory requirements affecting multiple departments; serve as an internal subject matter expert.
Communicate new and revised laws and regulatory guidance, summarize requirements, disseminate them, and analyze department responses.
Learn the Plan’s systems and data sources; identify compliance risks, issues, and barriers and recommend solutions or operational improvements.
Help ensure the Plan’s lines of business comply with CMS and DHCS contracts, DMHC Knox-Keene licenses, Covered California requirements, and other applicable regulations.
Review and research compliance issues and inquiries, interpret their underlying intent, and provide accurate responses and recommendations.
Advise and collaborate with internal departments to support adherence to regulatory guidance and recommendations.
Develop and recommend policies, procedures, standard operating procedures, and desk-top procedures when gaps, issues, or risks are identified.
Coordinate with departments on regulatory reporting and submission requirements; ensure requirements are applicable, appropriately captured in systems, and reportable.
Receive, research, coordinate, respond to, and track inquiries and submissions to CMS, DMHC, Covered California, and DHCS.
Validate reports and data before submission and assist departments with operational decisions related to reporting compliance.
Analyze and interpret the Knox-Keene Act and identify eFiling and submission requirements.
Prepare 1352(a) Amendments and Material Modifications for submission to DMHC; coordinate and respond to subsequent Comment Letters and amendments.
Report potential risks, non-compliance, or alleged violations to the Director of Compliance.
Assist the Manager, Regulatory Affairs in preparing the Plan for regulatory audits.
Participate in other compliance program components, including Privacy, Data Security, Code of Business Conduct and Ethics, and Fraud, Waste & Abuse.
Participate in relevant committees and work groups; develop reports and presentations with recommendations based on collected data.
Identify opportunities to improve the Compliance Department and participate in performance improvement initiatives.
Develop external and internal policies and procedures.