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Medicare/MAP Regulatory Affairs Analyst

Company: MetroPlus Health Plan
Location: New York
Posted on: September 25, 2022

Job Description:

Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealth 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, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewUnder the direction of the Director of Regulatory Affairs, the Medicare Regulatory Analyst will monitor and ensure compliance with state and federal regulatory requirements by building and maintaining a compliance infrastructure (including creating and updating of databases and tracking logs). The Medicare Regulatory Analyst is responsible for distributing, analyzing and monitoring the implementation of new or updated regulatory guidance; review, submission, and tracking business materials needing external approval; oversight of monitoring activities and dissemination of HPMS (Health Plan Management System) memos which advise on new rule-making or interpretative guidance (e.g., annual call letters) which can involve statutory and regulatory changes.Job Description

  • Monitor, distribute, interpret and analyze new laws, regulations and guidance applicable to specified business units. Work with business units to assess potential impact
  • Monitor changes to regulatory requirements and work with business units to identify changes needed to mitigate risks and achieve compliance. Work with business units to ensure implementation is complete and meets the regulatory requirement
  • Complete timely research for regulatory questions on department processes, policies and procedures, or materials for applicable business units
  • Review, submit and maintain tracking of materials sent to external regulatory agencies
  • Assist with external regulatory audits and regulatory reporting
  • Support other regulatory related activities as needed
  • Prioritizes and organizes own work to meet deadlines
  • Provides explanations and information to others on regulatory issues and requirementsMinimum Qualifications
    • A Bachelor's degree required; Master's or JD desired
    • 5-7 years' management experience in Managed Care Regulatory, Compliance or ProductProfessional 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, New York , Medicare/MAP Regulatory Affairs Analyst, Professions , New York, New York

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