- Competitive salary.
- Hybrid schedule.
- CalPERS retirement.
- State of the art fitness center on-site.
- Medical Insurance with Dental and Vision.
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development.
- Wellness programs that promote a healthy work-life balance.
- Flexible Spending Account Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
- Two (2) years of experience with managed care or other relevant industry experience.
- Experience in health care, health plans, Covered California, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect. Experience interacting with regulatory agencies.
- Bachelor's degree from an accredited university required.
- Knowledge of and experience with state and Federal regulatory and other requirements and practices related to Covered California, Medicare and Medi-Cal (Medicaid), Title 19 (USC)/Title 29 (USC and CCR), Title 22 (CCR), Title 28 (CCR), Title 42 (USC and CFR), CA Welfare and Institutions Code, and CA Health and Safety Code.
- Ability to work autonomously.
- Knowledge of Principles and practices of managed care.
- Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access.
- Must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.
-
Medi-cal Eligibilityspecialist
4 hours ago
Loma Linda University Loma Linda, United States**Education and Experience**:High School Diploma or GED required. Minimum three years of experience required in hospital-based registration, Medi-Cal, Customer Service and California Children's Services required with emphasis on Federal, State, and County eligibility regulations ...
-
Medi-cal Eligibilityspecialist
1 week ago
Loma Linda University Loma Linda, United States**Education and Experience**:High School Diploma or GED required. Minimum three years of experience required in hospital-based registration, Medi-Cal, Customer Service and California Children's Services required with emphasis on Federal, State, and County eligibility regulations ...
-
Analyst II Regulatory Affairs Medi-Cal
4 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United StatesWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience · The Analyst II, Regulatory Affairs has experience with and performs key centralized co ...
-
Analyst II Regulatory Affairs Medi-Cal
3 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · What you can expect · Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience · The Analyst II, Regulatory Affairs has experience with and performs key ...
-
Analyst II Regulatory Affairs Medi-Cal
3 days ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · What you can expect · Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an · authentic experience · The Analyst II, Regulatory Affairs has experience with and performs key ...
-
Analyst II Regulatory Affairs Medi-Cal
3 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United StatesWhat you can expectFind joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experienceThe Analyst II, Regulatory Affairs has experience with and performs key centralized complex an ...
-
Medi-Cal EligibilitySpecialist
6 days ago
Loma Linda University Medical Center Loma Linda, United StatesJob Summary: The Medi-Cal Eligibility Specialist assesses, advises, informs, and assists the uninsured and the underinsured patients in determining eligibility and liability for Inpatient, Outpatient, Emergency Room, Observation admission and services. Interviews patients or thei ...
-
Outreach Engagement/medi-cal Navigator
4 hours ago
Emanate Health West Covina, United States Full time**Current Emanate Health Employees - Please log into your Workday account to apply**: · Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, yo ...
-
coordinator, medi-cal billing
3 weeks ago
Pomona Valley Hospital Phillips Ranch, CA , USA, United StatesPosition Summary:#A strong technical person to assist the Supervisor in maintaining daily Business Office reports as well as weekly reports for the Manager/Director. Share responsibility with Supervisor in reviewing P#A#s to $5,000.00 or other designated amount. A backup to Super ...
-
Regulatory Production Specialist Ii
1 week ago
Inland Empire Health Plan Rancho Cucamonga, United States**What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an** **authentic experience** · The Regulatory Production Specialist II will be responsible for managing d ...
-
Regulatory Production Specialist Ii
1 week ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · **What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an** **authentic experience** · The Regulatory Production Specialist II will be responsible fo ...
-
Analyst I
1 week ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · **What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Under the direction of the Manager, Regulatory Affairs, the Anal ...
-
Eligibility Continuity Specialist
2 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United States**What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · **Perks** · IEHP is not only committed to healing and inspiring the human sp ...
-
Auditor - Provider Recovery
2 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United States**What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Under the direction of the Provider Claims Resolution & Recovery Supervisor, ...
-
Eligibility Continuity Specialist
2 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · **What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Additional Benefits: · **Perks** · IEHP is not only committed to ...
-
Auditor - Provider Recovery
2 weeks ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · **What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Under the direction of the Provider Claims Resolution & Recovery ...
-
Medical Biller
2 weeks ago
California Medical Billing Rancho Cucamonga, United States**About us** · California Medical Billing is a medical billing business in Rancho Cucamonga, CA 91730. · We are challenging, fast-paced and engaging. · Our work environment includes: · - Growth opportunities · - Casual work attire · - Flexible working hours · Full-time 40 hrs/wee ...
-
Analyst I
1 week ago
Inland Empire Health Plan Rancho Cucamonga, United States**What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Under the direction of the Manager, Regulatory Affairs, the Analyst I - Regu ...
-
Manager, Network Development
4 days ago
Inland Empire Health Plan Rancho Cucamonga, United States**What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Under the direction of the Director of Provider Network, the Network Develop ...
-
Manager, Network Development
4 days ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · **What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · Under the direction of the Director of Provider Network, the Net ...
Analyst II Regulatory Affairs Medi-Cal - Rancho Cucamonga, United States - Inland Empire Health Plan
Description
Overview:
What you can expect
Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience
The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department. Team Members in this position ensure plan operations, processes, procedures, policies, etc. are in compliance with regulatory agencies, including but not limited to, Covered California, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health Care (DMHC), in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.
Key Responsibilities:
1. Serve as the Plans internal subject matter expert by interpreting and applying a broad array of contract, legislative and regulatory requirements that affect multiple departments within the Plan.
2. Communicate new and revised laws and regulatory guidance that affect the Plan and interpret/summarize the requirements. Disseminate the requirements and analyze the responses. Disseminate the requirements and analyze the responses. Obtain an understanding of the various systems and data sources utilized by the Plan. Identify risks, issues, barriers with ensuring compliance and recommend solutions to the internal department which includes process and/or operational improvements.
3. Ensure the Plans lines of business are in compliance with contract(s) with the CMS, contract(s) with the DHCS, Knox-Keene license(s) with the DMHC, Covered California, and any other applicable regulatory agencies. Develops recommendations for appropriate action to ensure compliance.
4. Review and analyze compliance issues and inquiries from internal departments and applicable regulatory agencies, understand the underlying intent of the questions, and perform necessary research and analysis to provide accurate responses and recommendations. Advise and collaborate with internal departments to ensure adherence with guidance and recommendations provided. Develops and recommends policies and procedures, standard operating procedures, desk-top procedures where gaps, issues and/or risks are identified.
5. Collaborate with internal departments to ensure compliance with the Plans lines of business reporting and submission requirements to the CMS, the DHCS, the DMHC, Covered California, and any other applicable regulatory agencies. Responsible for receiving, researching, coordinating, responding timely and tracking all inquiries and submissions to the CMS, the DMHC, Covered California, and the DHCS. Collaborate with internal departments to ensure reporting and submission requirements are applicable to the Plans lines of business, captured in the systems appropriately and are reportable. Provide comprehensive data validation of reports prior to submission. Assist internal departments in making operational decisions to ensure compliance with reporting requirements.
6. Analyze and interpret the Knox-Keene Act; identify eFiling and submission requirements. Prepare 1352(a) Amendments and Material Modifications for submission to the DMHC. Receive, coordinate and respond timely to all subsequent Comment Letters and amendments.
7. Report potential risks, non-compliance or alleged violations to the Director of Compliance.
8. Under the direction of the Manager, Regulatory Affairs assist in preparing the Plan for regulatory audits.
9. Participate in and support other components of the Plans compliance program, such as Privacy, Data Security, Code of Business Conduct and Ethics, Fraud Waste & Abuse, etc.
10. Participate in relevant committees and work groups; develop reports and presentations with recommendations for appropriate action based on the analysis of collected data.
11. Proactively identify areas of improvement for the Compliance Department and participate in development of performance improvement initiatives.
12. Develop external and internal policies and procedures.
Commitment to Quality: The IEHP Team is committed to incorporate IEHPs Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits:Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Education & Experience
Key Qualifications
Start your journey towards a thriving future with IEHP and apply TODAY
Pay Range:USD $ USD $42.92 /Hr.