Health First Rockledge , FL 32956
POSITION SUMMARY To provide superior quality, competitive value and outstanding service by contributing to Health First Health Plans and Insurance's activities that support compliance with regulatory and contractual requirements. This individual will work with internal and external customers to ensure the integrity of all the health plan lines of business, critically analyzing and identifying areas of operational improvement.
Read, analyze, and interpret government regulations to acquire and maintain expert knowledge.
Effectively develop and present research outcomes in clear and concise reports and other communications as needed.
Coordinate the regulatory marketing process by reviewing and submitting all relevant records in accordance with governmental rules and regulations. Ensure the health plan remains compliant by maintaining accurate records, documents and a process for the collection, submission and reconciliation of all material.
Research and develop processes for implementation of the accounting for all lines of business regulatory communications, as well as identify and or establish policies and procedures to ensure compliance with Federal and State regulations.
Plan, coordinate and develop methodologies to monitor the compliance of the regulatory marketing across all lines of business.
Actively pursue continuing education opportunities to remain aware of changing standards, laws, rules and regulations; best practices, and new developments in healthcare as they relate to specific job duties.
Develop working relationships with key individuals and departments, responsible for the maintenance of regulatory documents.
Assist in coordinating and effectively communicating the health plan's position to regulators/auditors during all state and federal audits and site visits.
Provide objective and professional evaluations of the organization's operation and actively participate in identifying major opportunities for operational improvements as well as Compliance programs, audits and projects.
Assist the Director and Manager of Regulatory Affairs as needed.
Coordinate regulatory deliverables with Corporate Marketing to ensure timely and compliant distribution of documents.
Maintain tracking log to account for all member documents and regulatory marketing activities.
Assist in internal and external Marketing Audits and Data Validation Audits
Implement process improvements that will eliminate inaccurate regulatory documents released to members, providers, vendors and the general public.
Bachelor's degree in business preferred, or degree in relevant field required; or 3-5 years of related work experience preferred.
Excellent verbal and written communication skills including the ability to interact professionally with all levels of the organization.
Strong analytical and problem solving abilities.
Ability to handle multiple tasks and meeting deadlines in a fast-paced environment.
Proficient in Microsoft Office products, including Word, Excel and PowerPoint.
Knowledge and understanding of Health First Health Plans product offerings.
Ability to read, analyze and interpret professional/legal/medical documents, policies and procedures, government regulations, legislative issues and legal documents.
Ability to work independently with minimal supervision.
PAHM health care certification (will be required during the first year of employment).