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Medicare/MAP Regulatory Affairs Specialist

Company: Metroplus Health Plan Inc
Location: New York
Posted on: June 12, 2021

Job Description:

Medicare/MAP Regulatory Affairs Specialist

Job Ref: 60688

Category: Professional


Location: 50 Water Street, 7th Floor, New York, NY 10004

Job Type: Regular

Employment Type: Full-Time

Hire In Rate: $70,000.00

Salary Range: $70,000.00 - $78,989.00

About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus' network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Medicare/MAP Regulatory Affairs Specialist, reporting to the Associate Executive Director of Product Regulatory Affairs, plays an integral role in the oversight and management of product regulatory activities our Medicare and Medicaid Advantage Plus (MAP) Line of Business. The Medicare/MAP Regulatory Specialist is

responsible for promoting compliance with regulatory requirements to ensure department policies fulfill all Centers for Medicare & Medicaid Services (CMS) and NY State Department of Health (SDOH) regulations.

Job Description

  • Monitor, interpret, distribute, track, and assess new State and Federal regulatory guidance (including all HPMS memos, all CMS compliance/regulatory communications relative to Medicare & MAP compliance/regulatory communications.
  • Ensure that most recent contract changes are reflected in departmental policies and process by monitoring government, healthcare, and public websites, memos, and other sources to identify new and changed Medicare regulations and guidance.
  • Review and interpret State and Medicare regulatory guidance (i.e., Annual Call Letter, Final, Interim &Proposed Rules); prepare impact analysis for dissemination to business units for implementation of processes. Work with business units to ensure implementation is complete and meets the regulatory requirements.
  • Apply knowledge of regulations and health plan operations to support implementation of best practices for business areas i.e. Enrollment, Marketing, Retention/Customer Experience and Claims.
  • Provides support to internal business areas during the Medicare Annual Enrollment Period (AEP) including, but not limited to, the review, approval, submission and tracking of all marketing/sales materials including the Medicare/MAP webpages for all internal business areas.
  • Assist business areas with drafting required member, & provider notices and scripts to ensure CMS Regulatory requirements for Medicare & MAP.
  • Conduct Regulatory reviews of department policies, procedures and job aids, processes and workflows including revisions to ensure efficiency and adherence to Medicare & MAP regulations and requirements.
  • Complete timely research for regulatory questions on department processes, policies and procedures, or materials for Medicare & MAP to support internal business areas.
  • Participate and coordinate as needed the annual CMS readiness checklist reviews, annual Part C/D reporting, RADV audits and other ad hoc CMS and MAP regulatory requests, as needed.
  • Represent the department head at CMS or State meetings or webinars and conferences and internal meetings including taking meeting minutes and sharing with internal business areas, as needed.
  • Support Associate Executive Director in all other tasks assigned, as needed.

Minimum Qualifications

  • A Bachelor's degree required, Master's or JD desired
  • Three-Five years in a management position in a Managed Care Regulatory, Compliance or Product role.

Licensure and/or Certification Preferred


Professional Competencies

  • Broad-based in-depth knowledge of the managed care industry, including strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. The ability to comprehend and interpret regulatory, legislative, and contractual mandates
  • Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance oversight
  • High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.Simultaneously manage multiple projects
  • Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
  • The utmost integrity in the discreet and confidential handling of confidential materials is necessary

Keywords: Metroplus Health Plan Inc, New York , Medicare/MAP Regulatory Affairs Specialist, Other , New York, New York

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