Regulatory Specialist - Jefferson Health Plans

Jefferson Health Plans•Philadelphia, PA

2d•Onsite

About The Position

The Regulatory Specialist supports the organization's compliance with federal and state regulatory requirements related to all Jefferson Health Plans lines of business, currently Medicare Advantage, Medicaid, CHIP, and ACA Marketplace products. This role assists with monitoring regulatory developments, managing internal regulatory communications, coordinating regulatory submissions and responses, and maintaining regulatory documentation. Working under the guidance of senior regulatory staff, the Regulatory Specialist helps ensure timely dissemination and implementation of regulatory requirements across the organization while serving as a liaison between internal stakeholders and regulatory agencies.

Requirements

Bachelor’s Degree in Public Health, Health Administration, Healthcare Management, Public Policy, Business Administration, or a related field.
2 years of experience in Regulatory Affairs, Compliance, Health Policy, Healthcare Administration, Managed Care, Health Insurance Operations, or a related field
Experience working with federal and state healthcare programs, including Medicare, Medicaid, CHIP, and/or ACA Marketplace products.
Experience managing regulatory communications, tracking regulatory requirements, and coordinating cross-functional implementation activities.
Ability to analyze regulatory guidance and identify operational impacts and implementation considerations.
Attention to detail and accuracy when preparing, reviewing, and maintaining regulatory documentation.
Excellent written and verbal communication skills, including the ability to clearly summarize and communicate regulatory requirements to diverse audiences.
Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook.
Strong problem-solving and critical-thinking skills.

Nice To Haves

4 years of experience in Regulatory Affairs, Compliance, Health Policy, Healthcare Administration, Managed Care, Health Insurance Operations, or a related field
Experience with regulatory submission systems (e.g., PA DHS DocuShare, SERFF, HPMS, or similar platforms)
Understanding of health plan operations and cross-functional impacts of regulatory requirements is a plus

Responsibilities

Support the preparation, submission, and tracking of regulatory responses and documentation, including management of submissions through the Pennsylvania Department of Human Services (DHS) DocuShare system and other regulatory portals.
Manage the internal regulatory communication process, including monitoring incoming communications from CMS, DHS, state departments of insurance, and other regulatory agencies; assigning regulatory memoranda and guidance to appropriate business owners; and facilitating dissemination to impacted departments.
Collaborate with cross-functional teams to gather information and documentation necessary for regulatory submissions and program implementations.
Support the review and distribution of regulatory communications, guidance documents, and educational materials to internal stakeholders.
Participate in cross-functional meetings and workgroups to support implementation of new regulatory requirements and operational changes.
Respond to routine inquiries from regulatory agencies, internal business partners, and other stakeholders regarding regulatory requirements and submissions.
Develop and maintain working knowledge of CMS, state Medicaid, ACA Marketplace, and insurance regulatory requirements, escalating complex issues to senior regulatory leadership as appropriate.
Assist with updating and maintaining regulatory policies, procedures, and process documentation under the direction of senior regulatory staff.