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Regulatory and Compliance Analyst - Growing Healthcare Company - Hybrid Schedule

Company: Fallon Health
Location: Worcester
Posted on: May 25, 2023

Job Description:

About Fallon Health:Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nations top health plans for member experience and service and clinical quality.Brief Summary of Purpose:Responsible for ensuring that our Commercial and NaviCare/PACE LOBs are administered in a manner that comply with all applicable state regulations and contract requirements. Assist NaviCare/PACE Medicaid Program Manager with researching regulatory/contractual requirements and changes that impact Commercial and NaviCare/PACE products. Provide support during audits, filings, applications, and other projects as needed. Responsible for the development of plan documents (EOCs/Member Handbooks, Schedules of Benefits). Acts as a contact for benefit questions generated by other departments concerning those documents. Responsible for regulatory filing submissions under guidance of department Director or designee. Handle a variety of other projects related to the functions of the Regulatory Affairs and Compliance Department. Job Responsibilities:

  • Assist the NaviCare/PACE Medicaid Program Manager with the following:
    • Conduct research regarding regulatory/contractual questions to support business requirements including product development, procedural and operational issues, and changes for NaviCare/PACE products from a state perspective.
    • Conduct research and analyses of matters related to existing and new regulatory/contractual requirements.
    • Provide support to NaviCare/PACE product application submissions as needed.
    • Develop summaries on proposed and final regulatory bulletins and other regulatory communications for distribution to SMEs and follow-up actions.
    • Manage applicable Corrective Action Plans.
    • Develop, revise, and review department policies and procedures as needed.
    • Assist operational areas, as needed, with the development, updates and/or revisions to relevant policies and procedures based on updates to interpretation of regulatory changes from state regulators.
    • Coordinate with business areas to gather information needed for regulatory reviews, validations, and audits.
    • Attend meetings and regulatory calls as needed.
      • Develop and maintain plan documents (EOCs/Member Handbooks, Schedules of Benefits). Ensure that documents are completed in an accurate and timely fashion and comply with all regulatory requirements and meet the needs of internal and external customers.
        • Verify accuracy of content with internal subject matter experts.
        • Point of Contact for internal departments for information to be included in future documents.
        • Download approved plan documents to Clarity and post on ifallon.
        • Responsible for all changes to Schedule templates as a result of external regulatory requirements or internal product design changes.
        • Act as a contact for benefit questions generated by other departments concerning assigned documents.
        • Complete regulatory filings as directed including gaining a mastery of the Division of Insurance SERFF system.
        • Work with department Director on all phases of regulatory compliance with federal and state laws and regulations.
        • Serve as a Librarian for notifying and posting of Policies and Procedures from assigned Departments.Education:Bachelors degree in business, health care or related area required.License/Certifications:N/AExperience:
          • 2 years managed care or relevant industry experience
          • Regulatory/Compliance experience preferred
          • Legal experience a plus
          • Excellent interpersonal and communication skills, with the ability to write clearly and concisely.
          • High degree of organizational skills
          • Excellent time management skills - must demonstrate the ability to work independently, with strict deadlines imposed by governmental agencies.
          • Ability to interact with a wide range of professional levels
          • Strong attention to detail is a must
          • Fluency with Microsoft Office, Outlook, Microsoft PowerPoint, Excel, Adobe AcrobatFallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.Fallon Health Vaccination Requirements:To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as Remote require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. #AP23RequiredPreferredJob Industries

Keywords: Fallon Health, Worcester , Regulatory and Compliance Analyst - Growing Healthcare Company - Hybrid Schedule, Healthcare , Worcester, Massachusetts

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