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Regulatory Affairs and Compliance Program Analyst, Fairfield, CA


Organization: Partnership HealthPlan of California
Category: Professional
Location: Fairfield, CA
Date Job Posted: November 4, 2021
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Regulatory Affairs and Compliance Program Analyst

Job Locations US-CA-Fairfield
Job ID 2021-2007
FLSA Status Exempt

Overview

To support the objectives of the regulatory and compliance program and to ensure related activities are in alignment with regulatory requirements, contractual obligations, and ethical standards.

Responsibilities

  • Maintains awareness and demonstrates understanding of regulatory requirements, contractual obligations and professional standards that govern PHC as a Medi-Cal managed care plan (MCP)
  • Under direction of RAC leadership, performs quality assurance activities to assess the performance and work product of the RAC Unit. This may be achieved by analyzing that work outcomes are consistent with established criteria
  • Makes strategic recommendation(s) to improve the accuracy, quality, performance and/or increase efficiencies within the RAC unit
  • Assists in conducting risk assessments to identify potential areas of compliance vulnerability and areas at high risk of non-compliance; making recommendation for risk mitigation interventions
  • Supports auditing and monitoring activities to ensure compliance with governing rules, regulations, and accreditation standards; serving as a resource and providing guidance on compliance related matters
  • Under direction of RAC leadership, reviews and monitors development and implementation of corrective action plans
  • Responsible for writing summary reports of quality assurance and auditing/monitoring activities, which may include synthesis of complex information
  • Conduct root cause analyses to identify and resolve regulatory affairs and compliance related issues
  • Conducts analysis, collects information, and evaluates impact of regulatory and compliance issues to inform auditing and monitoring activities
  • Use analytical skills to resolve complex compliance, regulatory, and as applicable policy problems; and develop and evaluate alternatives, analyze data and present ideas and information effectively
  • With RAC Leadership, analyze impact of new programs/benefits and efficacy of existing RAC processes, policies, procedures and trainings
  • Consults with department leadership on a wide variety of compliance related subject matter areas
  • Represents RAC in various planning and collaboration efforts; this includes speaking and presenting at meetings
  • Supports RAC Leadership with regulatory change management efforts and quality improvement activities designed to mitigate compliance risks

Secondary Duties and Responsibilities

  • Participates in special projects and assignments, as assigned
  • Supports the maintenance of RAC policies, procedures, desktops and trainings.

Qualifications

Education and Experience

Bachelor’s Degree in health care related field preferred, with minimum of one (1) year experience in the health care regulatory affairs and/or compliance field, with knowledge of the Knox-Keene and Medi-Cal regulations; or an equivalent combination of education and experience (4-5 years minimum health care experience).

Special Skills, Licenses and Certifications

Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint and Excel. Knowledge of Policy development. State and federal legislative processes. Medi-Cal programs. Research and program planning methodology. Project Management. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments. Perform policy development and implementation in the areas of Medi-Cal, other insurance programs, long-term care, mental health, and other health-related programs. Demonstrated analytical skills. Ability to communicate effectively, both verbally and in writing. Perform Project Management activities.

Work Environment And Physical Demands

Ability to use computer keyboard and other business machines. More than 50% of work time is spent at a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 35 pounds

Additional Preferred Skills:

  • A minimum of 4-5 years experience in health care, preferably in managed care.
  • 1-2 years experience in regulatory affairs and/or compliance field, with knowledge of Knox-Keene and Medi-Cal regulations
  • Knowledge of policy development as well as state and federal legislative processes

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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