Associate Manager-Federal Regulatory Compliance (Remote)

American Specialty Health Incorporated

7d•Remote

About The Position

American Specialty Health Incorporated (ASH) is seeking an Associate Manager-Federal Regulatory Compliance to join our Regulatory & Program Compliance department. The primary purpose of this position is to oversee and manage the Regulatory Compliance Team to ensure compliance matters are addressed and handled within the timelines specified by law, regulation, and/or management. This includes keeping AVP-Regulatory and Program Compliance (Sr. Dir, RPC) and other senior management in the department apprised of regulatory matters that will impact the company.

Requirements

Bachelor’s Degree in English, similar field of study, or equivalent experience required. If equivalent experience, High School Diploma required.
3 years of experience with maintaining managed care related licenses and monitoring related regulatory compliance in a health insurance environment required.
Strong working knowledge of state and federal laws and regulations pertaining to managed health care and provider group administrative functions, including but not limited to, Utilization Review, Third Party Administration, downstream risk assumption and specialized physical medicine related health care services. Experience with all aspects of compliance regarding The Centers for Medicare & Medicaid Services “CMS” (with a focus on Medicare Advantage and Medicaid) and The California Department of Managed Health Care “DMHC” required.
Excellent research skills.
Strong analytical and writing skills.
Computer skills including word processing, Excel spreadsheets, SharePoint, CRM and email.
Demonstrated ability to manage and lead a small team.
Effective written communication skills.

Nice To Haves

Paralegal Degree and/or Certificate or law degree preferred.
Prior experience managing staff and working with cross-functional areas preferred.
Understanding of Department of Insurance, Department of Health Insurance Law, and/or Health Care Law preferred.

Responsibilities

Responsible for performance and oversight of regulatory compliance with laws, at the direction of department leadership and as a back up to the AVP, RPC’s, with respect to related compliance issues. Supports RPC Department activities by focusing on the following key accountabilities in relation to Federal Compliance and State Compliance:
Maintains required business licenses in a constantly changing regulatory environment. Demonstrates strong understanding of the business need for each license and the consistent ability to independently interpret the laws regarding licensing requirements for each license in assigned states. Appropriately escalates concerns and potential risks to supervisor but demonstrates ability to present solutions and take steps to proactively and appropriately address such concerns.
Communicates internally with various departments to understand detailed rationale of operations and to communicate detailed aspects of regulatory enforcement expectations of such operations. Also effectively communicates with internal departments to obtain and evaluate necessary information for regulatory filings based on the needs of each regulatory agency, in part by educating internal contacts on the unique regulatory environments in assigned states. Appropriately escalates concerns and potential risks to supervisor but demonstrates ability to present solutions and take steps to proactively and appropriately address such concerns
Communicates and coordinates externally with regulatory authorities to understand enforcement expectations. Demonstrates the ability to successfully negotiate with such authorities to achieve interpretations of regulatory requirements, consulting with supervisor on an ad-hoc basis regarding outcome of communication. Effectively educates external contacts regarding unique aspects of ASH’s business practices with limited need for involvement from management. Appropriately escalates concerns and potential risks to supervisor but demonstrates ability to present solutions and take steps to proactively and appropriately address such concerns.
Informs department leadership of all compliance issues, including legislative developments, for assigned responsibilities.
Supervises the functions of Compliance Coordinator(s), Associate Analyst(s), or State Analyst(s) and audits work performed by such persons to ensure compliance with department standards, company policy, accreditation standards and state and Federal law. Such functions involve, but are not limited to, Regulatory Reports Workgroup administration, Annual Legislative and Regulatory Reports Calendar, Action Item Closure Reporting, administration of ad hoc research requests, including 50 state research requests, monitoring new laws and regulations, communicating those developments in a timely manner to internal committees, maintaining regulatory filings and licenses, conducting regulatory research, and maintaining documentation in department files.
Effectively and efficiently monitors legislative and regulatory activity impacting company operations in assigned areas. Completes detailed legislative and regulatory reports for assigned states that includes assessments of impact to business operations, consulting with supervisor on an ad-hoc basis to resolve any high level or complex regulatory compliance issues. Effectively communicates such regulatory changes to organization through written communication and oral presentations to designated committees and senior management.
Performs detailed research, analysis and summarization of regulatory compliance issues reflecting a strong understanding of regulatory requirements and business operations and objectives. Recommends courses of actions regarding regulatory compliance issues and presents recommendations to internal stakeholders. Resolves ad-hoc compliance issues. Appropriately escalates concerns and potential risks to supervisor but demonstrates ability to present solutions and take steps to proactively and appropriately address such concerns.
Works with various departments and the regulatory compliance team to provide information and direction with regard to all regulatory agency and contractual requirements. Assist such departments in the resolution of issues.
Demonstrates subject matter expertise on regulatory enforcement expectations in a constantly evolving regulatory environment.
Supports department with regulatory compliance projects that impact regional and national service areas.
Supports the Compliance Office by assisting with annual policy and/or procedure review processes.
Supports and compiles documents for client reports based on knowledge of unique regulatory framework, while meeting required deadlines; such filings include but are not limited to the following: Part C reporting, ODAG Audit reporting, exclusion checks, preclusion checks and other Medicare contractual requirements; client requests for Medicare and Medicaid questionnaires and audit-assessments, and other reports based on delegated functions monitored by clients for compliance.
Responsible for ensuring the maintenance, review and development of policy, procedures and forms related to department processes.
Supports and provides lead role in representing the department at Key Process Team, Workgroup and Corporate Compliance Committee meetings as directed by the AVP, RPC.
Project management, and acquiring subject matter expertise, of specific compliance areas impacting assigned federal and state-specific subject matter and business operations specific to those federal/state matters as directed by the AVP, RPC.
Assumption of responsibility for additional states/areas as directed by the AVP, RPC either on a transitional basis or as needed.
Assists with training of new employees and other department staff as needed on a project basis at the direction of management.
As directed by the AVP, RPC, assists with training for other department staff and development of department procedures and protocols.
Updates and completes, at the direction of the AVP, RPC, annual and on-going compliance status reports and risk assessments for company operations.
Immediately informs supervisor of urgent issues.
Reports results of assessments to the AVP, RPC and conducts follow up on findings as directed by the AVP.
Works with internal departments to complete assessments and identify and remedy compliance concerns.
Completes all ASH University training requirements, including required regulatory trainings, as well as ad hoc trainings required by management, within required time frames.
Performs other duties as assigned.
Complies with all policies and standards.