Health Services Regulatory Analyst

Use Your Strengths as a Health Services Regulatory Analyst! 

About the opportunity: As a Health Services Regulatory Analyst you will ensure business practices in the Health Services department align and comply with legal regulatory and compliance needs. You will develop and build collaborative partnerships internally while serving as a resource for a broad array of regulatory requirements and compliance matters. You will also lead adherence efforts regarding regulatory requirements by reviewing and monitoring policies and guidelines within the Health Services department. Lastly you will obtain maintain and track regulatory and compliance updates. You will then analyze interpret and communicate these new and revised laws providing regulatory guidance to affected and/or exposed business areas to ensure compliance while also taking the right approach for our members. 

About you: You are inquisitive and a critical thinker always asking questions and aiming to solve problems. You have the keen ability to review regulatory guidelines and understand the potential business impact of the changes. You are organized and effectively prioritize work to complete initiatives timely. You actively build partnerships across the organization and thrive in a collaborative environment balanced with a role where taking ownership of work and initiative is important. You are a strong communicator and consultant you enjoy presenting business cases and making recommendations to influence critical healthcare quality work.  

NCQA and/or health insurance regulatory and compliance experience is a plus! 

This position will work a hybrid schedule of at least 3 days in Wellmarks Des Moines office (TuesdayThursday) with Monday & Friday remote option. 

Qualifications :

Required Qualifications Must have:

• Bachelors degree in a related field or equivalent experience.
• 3 years of health insurance health care or related industry experience including reading understanding applying and/or communicating established rules regulations guidelines or policies.
• Strong understanding of federal regulations.
• Demonstrated analytical skills to recognize inconsistencies research and conclude and careful attention to detail.
• Aptitude to learn and stay current on compliance best practices and industry regulations related to healthcare quality.
• Excellent verbal and written communication skills with the ability to understand and articulate complex information to a variety of stakeholders both internally and externally.
• Demonstrated strong interpersonal skills with the ability to develop strong relationships of collaboration and trust.
• Ability to consult with stakeholders on subject matter expertise and influence decisions appropriately.
• Proficiency with Microsoft Office with the technical aptitude to learn new systems quickly.
• Ability to travel up to 5%.

Preferred Qualifications Great to have:

• Health plan experience.
• Familiarity with NCQA standards.
• Strong data analysis skills.
• Strong process improvement skills.

Additional Information :

What you will do as a Health Services Regulatory Analyst:

a. Serve as a resource in reading regulations and laws and identifying impacts of new and/or changes will have on the business area.

b. Analyze and communicate with business areas and leadership to ensure apprised of regulatory matters.

c. Coordinate with the business areas in understanding requirements to assist with compliance implementation supported by written procedures.

d. Initiate investigation of potential compliance issues in accordance with department procedures ensuring appropriate business areas and leadership have an awareness of issues.

e. Lead initial discussions to clearly identify concern; understand potential scope harm impact and complexities identify root cause and make determination whether a compliance issue is present in accordance with department procedures.

f. Serve as subject matter expert for assigned business areas on regulatory business matters.

g. Attend and participate in meetings scheduled by the enterprise compliance office.

h. Facilitate the health services monthly regulatory business committee.

i. Communicate new and changing regulations/ laws to appropriate leaders and teams in business areas.

j. Meet with business area leadership to report and ensure adequate visibility of regulatory compliance initiatives.

k. Assist enterprise compliance office in identifying impacts and monitoring implementation efforts to ensure compliance with regulatory matters.

l. Monitor business areas compliance performance. Provide oversight to enterprisewide regulatory task matrix and validate business unit selfaudits. Proactively evaluate policies and procedures against regulatory requirements. Summarize and provide feedback on monitoring results identify areas for improvement and communicate back to the business stakeholders and Chief Compliance Officer as well as escalate any compliance issues as necessary.

m. Represent Wellmark on external regulatory calls. Compile and distribute content of regulatory calls to impacted business areas including training when necessary. Develop and distribute weekly regulatory emails to the Health Service Regulatory Liaison group.

n. Interact with enterprise compliance office as requested in regulatory compliance SharePoint site.

o. Work with compliance team members to create regulatory compliance tasks matrix and or KRPs.

p. Report any concerns of noncompliance to enterprise compliance office.

q. Other duties as assigned.

An Equal Opportunity Employer

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