Healthcare Policy Team Lead

Guidehouse•Tysons Corner, VA

1d•$113,000 - $188,000

About The Position

The Healthcare Review/Audit Policy Lead leads the identification, interpretation, and implementation of policy requirements governing Exchange review and audit activities. The role leads multiple policy team members by assigning responsibilities, setting priorities, and overseeing the quality and timely completion of their work. The position monitors federal and state policy changes, court rulings, annual Exchange regulations, sub-regulatory guidance, and system and operations documentation affecting Advance Premium Tax Credit (APTC) eligibility, Qualified Health Plan (QHP) eligibility, and Special Enrollment Periods (SEPs). It directs assessments of how changes affect Exchange Improper Payment Measurement (EIPM) methodology, establishes consistent policy interpretations for reviewers, and oversees updates to review unit logic, scripts, and review tools. The role also leads development and quality review of policy update deliverables, resolves or elevates policy questions, and coordinates with technical, review, and data teams to translate policy decisions into accurate and consistent review procedures and tools. Travel is required up to 10%. The position requires the ability to obtain Public Trust clearance.

Requirements

Bachelor’s degree.
Five or more years of relevant experience, including at least two years in a management capacity.
Experience with regulatory analysis.
Experience working in or knowledge of the Affordable Care Act, specifically Federally Facilitated Exchanges, State-Based Exchanges, and health insurance markets and exchanges.
Ability to oversee multiple concurrent workstreams.
Excellent verbal and written communication skills.
Strong stakeholder management skills and experience.
Ability to obtain Public Trust clearance.

Nice To Haves

Ability to navigate ambiguity and provide clear guidance, direction, and structure to the team.
Flexibility and agility in responding to changing requirements in a dynamic environment.
Skills in developing training on regulatory updates and training team members on the impact of changes.
Proficiency working with compliance team members and developers to confirm regulatory changes are properly reflected in testing methodology and automation scripts.

Responsibilities

Lead the identification, interpretation, and implementation of policy requirements governing Exchange review and audit activities.
Lead multiple policy team members by assigning responsibilities, setting priorities, and overseeing the quality and timely completion of their work.
Monitor federal and state policy changes, court rulings, annual Exchange regulations, sub-regulatory guidance, and system and operations documentation affecting APTC eligibility, QHP eligibility, and SEPs.
Direct assessments of how policy changes affect EIPM methodology.
Establish policy interpretations for consistent application by reviewers.
Oversee updates to review unit logic, scripts, and review tools.
Lead the development and quality review of policy update deliverables.
Resolve or elevate policy questions.
Coordinate with technical, review, and data teams to translate policy decisions into accurate and consistent review procedures and tools.