Will review, interpret and communicate regulatory guidance for all departments within Peoples Health and to the Delegation Oversight team for communication to
first tier, downstream, and related entities (FDRs) and to provide regulatory guidance and interpretation as required to all PH staff necessary to meet the regulatory requirements established by the Centers for Medicare and Medicaid Services (CMS), DOI and other regulatory organizations.
Responsible for the communication of regulatory requirements, communications
and reports from CMS and other regulatory organizations to applicable PH Departments and to the Delegation Oversight team for communication to the FDRs. Also responsible for building and maintaining effective lines of communication and working relationships with the department specific compliance staff.
- Review, interpret and disseminate regulatory communications released by CMS and other regulatory organizations through Compliance 360 to affected PH departments and FDRs
- Research and provide regulatory guidance and interpretation to PH internal staff inquiries based on the Medicare Managed Care Manual, Medicare Prescription Drug Manual, Medicare On-Line Manuals and other regulatory guidance
- Provides guidance and oversight to operational deaprtments' compliance staff throughout the organization to ensure regulatory requirements are met including the interpretation and implementation of regulatory guidance
- Responsible for the coordination of Training and Education and Policies and Procedures provided by the Compliance department
- Documents all internal staff inquiries in the regulatory inquiries database and assist the Regulations and Guidance Manager in identifying opportunities for improvement based on the inquiries received
- Assist with the creation of training materials and presentations required based on changes in regulatory guidance or through the identification of opportunities for improvement based on inquiries or through coordinated efforts with the department specific compliance staff
- Assist in maintaining the Compliance Workspace in Compliance 360 by creating and revising new content as needed to meet the requirements of newly released CMS regulations and build/update the evidence rooms as needed to ensure the plan's compliance with CMS regulations and other regulatory guidance
- Review all proposed and final rules and regulations as released from CMS and other regulatory organizations and provide written communications to Compliance department management of its contents
- Review and submit comments, when necessary, for all assigned internal marketing reviews prior to their submission to CMS for approval
- Participate in all webinars, seminars and conference calls applicable to the CMS and other regulatory requirements as assigned by management
- Participate in company implementations and initiatives as assigned by management
- Assist in preparation activities for CMS regulatory site visits and reviews
Bachelor's degree preferred and/or a minimum of 3 years related work experience in the managed care industry, preferably in a Medicare Advantage Plan, preferably in all areas of Managed Care. Previous research experience is required. Excellent oral and written communication skills a must. Must have experience with word processing, spreadsheets and database management skills. Must be able to work independently and meet deadlines.
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