Come join an organization that makes a difference in the underserved San Francisco Communities! At San Francisco Health Plan (SFHP), we are currently looking for a Regulatory Affairs Legal Analyst.
Under the supervision of the Regulatory Affairs Counsel, the Analyst is responsible for legal analytical functions within the Regulatory Affairs and Compliance department. Activities range from routine to complex, requiring excellent judgment and decision-making abilities. The Analyst will take the initiative to determine proper approach or action to take in non-routine situations. The position requires extensive knowledge of State health care programs and health plan processes, as well as substantial expertise in the areas of health care compliance, laws, regulations and new health care reform initiatives at the local and statewide levels (e.g. Medi-Cal expansions and children’s health programs).
The ideal candidate is a professional, demonstrating high standards of integrity and confidentiality. This person will enjoy interacting with people at all levels, thrive in a fast-paced environment, ability to adapt to shifting priorities, and work with minimal supervision. Possessing strong organizational skills and attention to detail, the Analyst will multi-task and maintain strict confidentiality while carrying out activities and assisting Compliance & Regulatory Affairs department team members. In addition, this individual may take the lead role on department and assigned organization-wide projects.
WHAT YOU WILL DO
- Coordinate and timely file reports and filings to regulatory agencies, mainly the Department of Health Care Services and the Department of Managed Health Care.
- Collect evidence, draft responses, and represent the organization in provider complaints, State Fair Hearings, Independent Medical Review requests and Consumer Complaints.
- Develop and deliver oral arguments at State Fair Hearings.
- Collaborate with contracting team to complete timely review of provider and vendor contracts
- Draft, prepare, and track regulatory filings including filings about new and amended provider and vendor contracts
- Prepare timely responses to inquiries from state agencies, including ad hoc inquiries.
- Performs legal analysis and communicates impact of new state regulatory requirements and guidance (e.g., All Plan Letters) to other staff
- Independently conduct legal, regulatory, and other health care-related research on a wide variety of issues including access and availability, utilization management, grievances and appeals, and claims processing.
- Draft written findings of research.
- Manage and respond to subpoenas, third party liability, and records requests, including reviewing records provided by internal departments prior to production.
- Assist with review of the validity of member requests for Authorized Representatives/Personal Representatives.
- Develop and support implementation of policies and procedures in compliance with federal and state laws.
- Serves as one of the Compliance & Regulatory Affairs Department liaisons to state agencies.
- Assists in coordination of audits by governmental agencies.
- Leads and/or coordinates implementation of new legislation, regulations and regulatory guidance, as assigned.
- Assists with coordinating inter-departmental activities as relevant to the Compliance and Regulatory Affairs department
- Assists with coordinating workflow of key processes of the Compliance & Regulatory Affairs Department and recommends new processes as needed
- Provides consultation and trains other staff on regulatory requirements
- Appropriately refers substantive questions / key business issues to others and follows up to ensure resolution on behalf of manager
- Performs special assignments for manager, which require researching and collecting information needed to complete projects or reports; locating, analyzing and summarizing data to identify variances and provide recommendations; and producing reports requiring specialized content knowledge, which may be the basis of significant decisions
- Supports the Regulatory Affairs Counsel and colleagues as needed.
WHAT YOU WILL BRING
- Bachelor’s degree required; JD or paralegal certificate, strongly preferred
- Healthcare Compliance Certification preferred
- Minimum of two plus years of analyst experience in a health plan environment preferred
- Strong working knowledge of State program regulations, healthcare compliance, and HIPAA required
- Knowledge of Medi-Cal managed care and Knox-Keene Act preferred
- Excellent communication skills required
- Excellent attention to detail and organizing abilities
- Excellent logic, planning and problem-solving skills
- Strong time management, complex project management skills and multi-tasking abilities
- Advanced level proficiency with MS Office applications
San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 140,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.