Regulatory Affairs Specialist II

Partnership HealthPlan of California•Fairfield, CA

8h•Onsite

About The Position

The Regulatory Affairs Specialist II supports the plan-wide regulatory affairs and compliance program, including activities related to HIPAA and Fraud, Waste, and Abuse (FWA). This role, under the supervision and direction of the Regulatory Affairs Manager, monitors daily Regulatory Affair unit’s operations to ensure the timeliness of deliverables and all case management performance metrics are met. The specialist performs internal auditing of all privacy and FWA cases to ensure they meet DHCS requirements and Partnership professional standards. Additionally, the position provides support to the Regulatory Affairs Specialist (RAS) and directs complex regulatory inquiries and responses to regulatory agencies.

Requirements

Bachelor’s degree in relevant field or equivalent combination of education and experience
Minimum of two (2) years’ experience as a Regulatory Affairs Specialist or relevant experience in managed care with knowledge of the Medi-Cal, and NCQA requirements
Experience with the investigation and reporting of HIPAA and FWA related incidents
Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint, Excel, Project
Typing speed of 30 wpm
Valid California driver’s license
Proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business
Excellent oral and written communication skills
Excellent organizational skills with ability to prioritize assignments, maintain effective filing systems, and meet deadlines
Ability to work under minimal supervision and exercise independent judgment
Diplomacy and tact in handling sensitive information regarding personnel affairs
Ability to interact with executives and vendors effectively, handling all assignments with efficiency
Ability to handle multiple tasks and meet deadlines
Excellent judgment

Nice To Haves

Knowledge of Medicare and Knox Keene requirements

Responsibilities

Proficiently performs all duties of the Regulatory Specialist, independently.
Operates independently, exercising judgement, and providing support and guidance to Regulatory Affairs and Compliance (RAC) staff
Encourages continuous awareness and education of unit staff, which may include development and maintenance of training materials
Creates and monitors daily operational reports to ensure the timely submission of privacy and FWA cases to DHCS
Manages the intake and ongoing maintenance of referral/inquiry platform
Ability to assess, facilitate, and see to completion, referrals and inquiries, of varying complexity and scope, submitted to RAC
Monitors unit trackers to ensure the timeliness of deliverables are met, making recommendation for improvements in tracking and/or work flows as necessary
Ability to direct unit work, which may include leading unit meetings/discussions and assessment of work outcomes
Competent in assessing and analyzing unit work consistent with established criteria and providing education/training to unit staff as needed
Maintains awareness and understanding of regulatory requirements that govern unit responsibilities
Makes strategic recommendation(s) to improve the accuracy, quality, and/or reporting of case investigations based on audit observations in order to enhance HIPAA and FWA case management performance
Leads or participates in Regulatory Affairs unit projects and has the capacity to represent unit in cross-departmental projects
Assists Regulatory Affairs Manager with developing and maintaining compliance training program including but not limited to: Updating new hire compliance trainings and annual training materials; Conducting targeted department trainings
Acts as a trainer for the Regulatory Affairs unit
Backup trainer for new hire trainings or other department trainings
Works with departments on resolving complex regulatory required submissions
Assists Regulatory Affairs Manager with duties related to chairing the PTAS and FWA Subcommittees
Supports regulatory submission process including awareness of deliverables, ad hoc and routine, and completeness and timeliness of submissions
Assists Regulatory Affairs and Compliance unit with the administrative functions to support unit meetings, workgroups, projects and external audits
Other duties as assigned