Fallon Health

  • Regulatory Specialist - Plan Documents - Compliance - Growing Health Plan

    Location US-MA-Worcester
    Posted Date 1 week ago(12/5/2018 11:17 AM)
    Job ID
    5440
    # Positions
    1
    Category
    Corporate Compliance
  • Overview

    About Fallon Health

     

    Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

    Brief summary of purpose:

    Creates plan documents (EOCs/Member Handbooks, Schedules of Benefits). Acts as a contact for benefit questions generated by other departments concerning those documentsSubmit regulatory filings under guidance of department Director. Handles a variety of other projects related to the functions of the Regulatory Affairs and Compliance Department.

     

    Responsibilities

    Plan Documents

    •  Develops and maintains plan documents (EOCs/Member Handbooks, Schedules of Benefits). Ensures that documents are completed in an accurate and timely fashion, and comply with all regulatory requirements and meet the needs of internal and external customers who will use them.
    • Creates EOCs/Member Handbooks for DOI and large client (ASO) review and approval.
      • Verifies accuracy of content with internal subject matter experts.
      • Works with Sales contact to ensure the document is reviewed and approved by large ASO clients.
      • Point of Contact for all departments in the company for information to be included in future documents.    
      • Downloads approved plan documents to Clarity and posts on ifallon.  
      • Produces Schedules of Benefits which are included with EOCs/Member Handbooks. Works with other departments to ensure timely and accurate completion of Schedules.
      • Responsible for all changes to Schedule templates as a result of external regulatory requirements or internal product design changes.
    • Provides support for all departments in the company in relation to benefits, including monitoring and resolving Avenue requests, responding to benefit inquiries, and completing benefit-related RFP questions as needed.

    Regulatory

    • Works with Director and Sr. Regulatory Analyst in the department on all phases of regulatory compliance with federal and state laws and regulations.
    • Completes regulatory filings as directed including gaining a mastery of the SERFF system
    • Provides guidance and answer questions concerning state and federal benefit mandates
    • Follows developments at various regulatory agencies such as the Division of Insurance, Massachusetts Health Connector, Health Policy Commission, CMS (ACA) and Center for Health Information and Analysis
    • Participates in MAHP and AHIP activities  

    Handles other projects related to regulatory, benefits, compliance or other department matters, as needed.

    Qualifications

    Education

    Bachelor’s degree in business, health care or related area required.

     

    License/Certifications

    N/A

     

    Experience

    • Minimum three years’ experience in managed care industry
    • Fluency with Microsoft Office
    • Legal/Regulatory/Compliance experience preferred.  
    • Will possess excellent interpersonal and communication skills, with the ability to write clearly and concisely.
    • High degree of organizational skills
    • Excellent time management skills - must demonstrate the ability to work independently, with strict deadlines imposed by governmental agencies.
    • Ability to interact with a wide range of professional levels
    • Strong attention to detail a must

     

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