Manager, Regulatory Affairs

  • Convey Health Solutions
  • Dania Beach, FL, USA
  • Feb 14, 2020
Full time Government

Job Description

Convey Health Solutions is seeking a strong business-oriented and hands-on Manager, Regulatory Affairs to lead a team of compliance analysts and auditors


OUR MISSION

To improve health plan operations and elevate the customer experience.


OUR VISION

Empowering health plans to excel through technology, service and advisory experience


WHAT WE DO

At Convey Health Solutions, we manage a myriad of administrative needs and make it easier for health plans to operate and provide valuable experiences for their members. How so? We focus on building specific technologies and services that uniquely meet the needs of government-sponsored health plans.


Are you ready to join a winning team? We want to tap into your experience and enthusiasm to help health plans streamline member management.


As a dynamic company, we offer an environment of learning, caring, and support of personal goals. Every team member is valued for his or her commitment to our cause, and for the contributions to our success.


Essential Responsibilities:

  • Ensures all Medicare and Medicaid product and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
  • Drafts policies, procedures, and process to comply with federal program regulations, and any applicable state regulations
  • Provides guidance to various Corporate and Health Plan departments regarding CMS compliance issues and implementation of new compliance requirements with respect to regulatory and contract language
  • Identifies, evaluates and analyzes the impact of CMS and Medicare regulatory issues and advise management concerning impact
  • Reports all Medicare and Medicaid product monthly universe review results and escalate issues in accordance with the risk reporting policies
  • Oversees the Universe Medicare Automation tool and work with appropriate IT/business partners to make necessary updates


Education & Experience:

  • Five years of experience in data analysis, compliance auditing, program evaluation, management or policy analysis, and/or, compliance and performance auditing for a health plan
  • Bachelor's degree in Business or Healthcare required
  • Knowledge of and experience with the monitoring and tracking of government communications to include Health Plan Management System (HPMS) Memos, Office of Inspector General (OIG) Fraud Alerts and Advisory Opinions, and Federal Register and PRA Publications
  • Two plus years' experience with health plan grievance processes and CTMs preferred
  • Three year's plus years, acting as a compliance leader overseeing a Fraud Waste and Abuse (FWA) healthcare compliance program
  • Three plus year's experience managing and coordinating interactions with Center for Medical & Medicaid Services (CMS), Office of Inspector General (HHS OIG) and other similar federal and state healthcare regulators, including responding to and documenting


´╗┐Benefits:

  • Medical, dental & vision plans
  • 401K Plan, including company match
  • Life insurance - company paid & voluntary
  • Short & Long term disability
  • Discounts and savings options
  • Company engagement sponsored events