Analyst II - Regulatory Affairs (hybrid)

Inland Empire Health Plan•Rancho Cucamonga, CA

3d•Hybrid

About The Position

The Analyst II, Regulatory Affairs performs centralized, complex regulatory activities for the Compliance Department under the direction of the Manager, Regulatory Affairs. The role helps ensure that Plan operations, processes, procedures, and policies comply with applicable requirements from agencies including Covered California, CMS, DHCS, and DMHC. The position interprets regulatory and contractual requirements, assesses compliance risks, coordinates regulatory submissions and inquiries, and works with internal departments to recommend and implement appropriate compliance actions and operational improvements. It also supports regulatory audits and other components of the Plan’s compliance program, and contributes to quality goals including HEDIS, CAHPS, and NCQA Accreditation. The position follows a hybrid schedule: remote Monday and Friday, onsite Tuesday through Thursday in Rancho Cucamonga, California.

Requirements

Two years of experience in managed care or another relevant industry.
Experience in healthcare, 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 regulatory 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 insurance standards, with no more than three points, to drive company vehicles.
Knowledge of managed care principles and practices.
Strong interpersonal and presentation skills for communicating with internal departments and external agencies.
Ability to convey project objectives clearly and effectively.
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.
Demonstrated 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 in a team environment.

Responsibilities

Serve as an internal subject matter expert by interpreting and applying contract, legislative, and regulatory requirements affecting multiple departments.
Communicate new or revised laws and regulatory guidance, summarize requirements, disseminate them, and analyze departmental responses.
Learn the Plan’s systems and data sources, identify compliance risks and barriers, and recommend process or operational improvements.
Ensure lines of business comply with applicable CMS and DHCS contracts, DMHC Knox-Keene licenses, Covered California requirements, and other regulatory requirements.
Develop recommendations and advise internal departments on actions needed to achieve compliance.
Research and analyze compliance issues and inquiries, determine their underlying intent, and provide accurate responses and recommendations.
Develop or recommend policies, procedures, standard operating procedures, and desk procedures when gaps, issues, or risks are identified.
Coordinate with internal departments to ensure regulatory reporting and submission requirements are understood and met.
Receive, research, coordinate, respond to, and track inquiries and submissions to CMS, DMHC, Covered California, and DHCS.
Verify that reporting and submission requirements apply to the Plan’s lines of business and are properly captured in systems and reported.
Validate reports before submission and assist internal 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, and coordinate responses to subsequent Comment Letters and amendments.
Report potential risks, non-compliance, or alleged violations to the Director of Compliance.
Assist in preparing the Plan for regulatory audits under the direction of the Manager, Regulatory Affairs.
Support 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 and develop reports and presentations with recommendations based on analysis.
Identify opportunities to improve the Compliance Department and participate in performance improvement initiatives.
Develop internal and external policies and procedures.