Will be assigned to and work closely with assigned business department (s) to help assure that the department (s) is in full compliance with all relevant rules and regulations. The Lead will provide regulatory and operational subject matter expertise, both clinical and administrative, for interpretation, testing, monitoring and adherence to requirements. This Lead position will help to fill existing knowledge, skill and monitoring gaps in the business operations while increasing oversight and support for critical Product compliance activities. This position will work with the assigned Compliance liaison for operations to identify, interpret, and communicate new and revised Product regulatory requirements. Responsibilities include implementation of new or revised regulatory changes, monitoring, tracking, and testing implementation of all Product requirements. Working under the Director Product Regulatory Operations will coordinate with the business department (s) leadership to construct the corrective action plan that best supports our internal process and resources, while fully responding to the issues identified by State and Federal regulatory departments. The Lead Product Regulatory Operations Specialist ensures that resolutions are implemented in a timely fashion. The Lead Product Regulatory Operations Specialist will maintain tools that track and accurately record all compliance issues, assure successful implementation of required changes and adherence to quality standards. Will also implement processes and reports that will assist management in identifying and stratifying existing and potential operational issues that impact EmblemHealth’s program from a regulatory perspective. The Lead Product Regulatory Operations Specialist will work with the department’s management on a day to day basis to implement changes aimed at proactive management of risk areas, provide data and reports that will assist the Director in creating responses to regulatory agencies issues. The Lead Product Regulatory Operations Specialist will produce routine and ad hoc compliance reports for to management as required, will assist management in the department (s) in the resolution of regulatory compliance issues, as well as provide regulatory guidance.
- Review and interpret product regulatory guidance related to operational policies. Dissemination of regulatory product guidance to business department for implementation of processes. Review guidance to identify and stratify existing and potential operational issues that impact EmblemHealth’s products from a regulatory perspective.
- Work with the business department’s management on a day to day basis to implement changes aimed at proactive management of risk areas, provide data and reports that will assist in creating responses to regulatory issues.
- Producing routine and ad hoc compliance reports to management as required will assist management in the functional areas in the resolution of regulatory compliance issues, as well as providing regulatory guidance.
- As a result of product monitoring, oversee the coordination with business department’s leadership to construct the corrective action plan that best supports our internal processes, while fully responding to the product regulatory issues identified.
- Lead large scale projects and collaborate efforts for maintenance and development of regulatory program initiatives related to regulations. Support the development of regulatory and operational business requirements for ‘best practice’ implementation of Regulatory rules and regulations.
- Bachelor’s degree required
- 4 -6 years’ work experience in regulatory healthcare operations compliance required
- Thorough knowledge of State and/or Federal programs operations and regulations required
- Proficiency in the use of Microsoft Office (Word, Excel and Access) required
- Strong analytical skills required
- Proven ability to establish and maintain relationships of trust with departmental staff and management required
- Proven ability to coordinate and lead interdepartmental work teams and meet established goals required
- Must be goal oriented and able to meet tight deadlines while handling multiple priorities required
- Must be a team player and able to take direction from multiple sources required
- Must be highly organized, able to handle multiple assignments with overlapping deadlines. Must have the ability to show attention to detail required
- Excellent communication skills (written and verbal) required. Ability to communicate clearly and concisely with EmblemHealth staff and management required
- Ability to arrange work schedule to meet deadlines from multiple sources, and engage staff throughout EmblemHealth to assist in the completion of duties required
Attention To Detail