Regulatory Operations Coordinator

Now hiring a Regulatory Operations Coordinator

The Regulatory Coordinator supports the Regulatory Operations Managers with Presbyterian Health Plan (PHP) commercial, Affordable Care Act and government program regulatory compliance activities (e.g. Medicare and Medicaid). Major duties include, but are not limited to, assisting the Managers of Regulatory Operations with identifying new regulatory and legal requirements and existing with appropriate implementation of such requirements in operational areas; performing regulatory research and analyses to assist to assist operational areas,; coordinating and reviewing responses to regulatory agency inquiries to ensure high quality and timely submission of responses via the required system, e.g. SERFF (OSI/NAIC) and HIOS (CMS), etc..; and monitoring business processes and regulatory responses to ensure ongoing compliance and follow-up on regulatory submissions. The Regulatory Coordinator is required to interact directly and with a high degree of professionalism with health plan staff, other PHS staff and the staff of various external regulatory entities. Performs complex technical and analytical work under supervision of Regulatory Operations Managers and Director in support of the PHP commercial, ACA, and government program health plans. Communicates regulatory submissions calendars/timelines to PHP community stakeholders to ensure appropriate review time for subject matter experts in such areas as Member Materials, Finance, Actuatrial Services, etc. The coordinator may monitor and implement systems to ensure submission deadlines and other requirements are met.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

• Bachelors Degree or experience sufficient to substitute for degree in accordance with company standards is required.
• Additionally, one-to-three years experience in health plan management or regulatory/compliance is required.
• Specific experience with government health plan regulatory/compliance preferred.

• Works closely with the Managers of Regulatory Operations to: (1) ensure compliance with contractual and regulatory requirements; (2) identify compliance issues associated with new regulations/guidance and service areas. (3) Communicate with regulators, state and local groups, organizations, or committees related to government program health plans including primary point of contact for regulatory submissions through SERFF (OSI/NAIC) and HIOS (CMS).
• Supports regulatory inquiries, reporting and submissions requirements, and audits regarding government program health plans. This includes collecting materials, reviewing and quality checking information, and site visit facilitation
• Tracks federal and state laws, regulations, and new legislation related to the PHP government program health plans (Medicare and Medicaid, i.e., Centennial Care) under supervision of Regulatory Managers.
• Assists the Manager of Regulatory Operations with monitoring CAP and regulatory inquiries on submissions and other inquiries.
• Participates in PHP Regulatory Operations team meetings and functional area team meetings, as appropriate

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.