Regulatory Specialist - Plans

Job Details

The Regulatory Specialist supports the organization's compliance with federal and state regulatory requirements related to all Jefferson Health Plans lines of business, currently Medicare Advantage, Medicaid, CHIP, and ACA Marketplace products. This role assists with monitoring regulatory developments, managing internal regulatory communications, coordinating regulatory submissions and responses, and maintaining regulatory documentation. Working under the guidance of senior regulatory staff, the Regulatory Specialist helps ensure timely dissemination and implementation of regulatory requirements across the organization while serving as a liaison between internal stakeholders and regulatory agencies.

Job Description

Summary
The Regulatory Specialist supports the organization's compliance with federal and state regulatory requirements related to all Jefferson Health Plans lines of business, currently Medicare Advantage, Medicaid, CHIP, and ACA Marketplace products. This role assists with monitoring regulatory developments, managing internal regulatory communications, coordinating regulatory submissions and responses, and maintaining regulatory documentation. Working under the guidance of senior regulatory staff, the Regulatory Specialist helps ensure timely dissemination and implementation of regulatory requirements across the organization while serving as a liaison between internal stakeholders and regulatory agencies.

Job Duties

• Support the preparation, submission, and tracking of regulatory responses and documentation, including management of submissions through the Pennsylvania Department of Human Services (DHS) DocuShare system and other regulatory portals.
• Manage the internal regulatory communication process, including monitoring incoming communications from CMS, DHS, state departments of insurance, and other regulatory agencies; assigning regulatory memoranda and guidance to appropriate business owners; and facilitating dissemination to impacted departments.
• Collaborate with cross-functional teams to gather information and documentation necessary for regulatory submissions and program implementations.
• Support the review and distribution of regulatory communications, guidance documents, and educational materials to internal stakeholders.
• Participate in cross-functional meetings and workgroups to support implementation of new regulatory requirements and operational changes.
• Respond to routine inquiries from regulatory agencies, internal business partners, and other stakeholders regarding regulatory requirements and submissions.
• Develop and maintain working knowledge of CMS, state Medicaid, ACA Marketplace, and insurance regulatory requirements, escalating complex issues to senior regulatory leadership as appropriate.
• Assist with updating and maintaining regulatory policies, procedures, and process documentation under the direction of senior regulatory staff.

Minimum Qualifications

• Bachelor’s Degree in Public Health, Health Administration, Healthcare Management, Public Policy, Business Administration, or a related field.
• 2 years of experience in Regulatory Affairs, Compliance, Health Policy, Healthcare Administration, Managed Care, Health Insurance Operations, or a related field
• Experience working with federal and state healthcare programs, including Medicare, Medicaid, CHIP, and/or ACA Marketplace products.
• Experience managing regulatory communications, tracking regulatory requirements, and coordinating cross-functional implementation activities.
• Ability to analyze regulatory guidance and identify operational impacts and implementation considerations.
• Attention to detail and accuracy when preparing, reviewing, and maintaining regulatory documentation.
• Excellent written and verbal communication skills, including the ability to clearly summarize and communicate regulatory requirements to diverse audiences.
• Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook.
• Strong problem-solving and critical-thinking skills.

Preferred Qualifications

• 4 years of experience in Regulatory Affairs, Compliance, Health Policy, Healthcare Administration, Managed Care, Health Insurance Operations, or a related field
• Experience with regulatory submission systems (e.g., PA DHS DocuShare, SERFF, HPMS, or similar platforms)
• Understanding of health plan operations and cross-functional impacts of regulatory requirements is a plus

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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