Regulatory Analyst, Sr

Position Summary:

 

The Sr. Regulatory Analyst will communicate with Information Technology (IT), Heritage Provider Network Clinical Services (HPN CS) and other departments within the organization to become an expert on Regulatory Health Plan Utilization Management (UM) correspondence templates for all lines of businesses.  The Senior Analyst will also serve as a mentor and will monitor the workflow of the Analyst I as well as serve as the oversight with the letter testing process.

 

Essential Duties and Responsibilities include the following:

 

1. Perform secondary reviews of letter testing conducted by Analyst I, ensuring adherence to departmental procedures.
2. Assist in and ensure accuracy and timeliness of SharePoint uploads through secondary review processes.
3. Act as a mentor and participate in training initiatives for Analyst I.
4. Examine letters returned from HPN with errors, and coordinate with IT and Analyst I for necessary corrections.
5. Coordinate the finalization and submission of letter templates to HPN Corporate.
6. Oversee the management of pending letters in HPN’s Smartsheet for assigned health plans.
7. Manage and maintain the P Drive, ensuring it is up-to-date with current letter templates.
8. Participate in scheduled meetings and provide regular updates on the status of assigned health plans.
9. Serve as the primary contact for inquiries related to letter issues between IT and the Letters Team.
10. Provide assistance in addressing audit inquiries concerning health plan templates.
11. Identify improvement opportunities in letter testing processes for Analyst I and the broader testing framework.
12. Proactively detect and escalate potential compliance issues.
13. All other duties as directed by management.

Organizational Responsibilities :

 

1. Proactively support and practice company mission, vision and values.
2. Follow Employee Handbook guidelines and company policies and procedures.
3. Follow established departmental dress code.
4. Appropriately and accurately maintain time keeping records.
5. Adhere to attendance policy and time off requests.
6. Follow safety policies and procedures.
7. Be flexible and adaptable and courteous and promote professionalism.
8. Communicate verbally and in writing through appropriate channels.
9. Maintain confidentiality at all times in compliance with company policy and HIPAA requirements
10. Employee has completed all required annual Compliance training and signed attestation form is attached for each module

 

The pay range for this position at commencement of employment is expected to be between  $29 - $31 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

 

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

 

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

 

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

 

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

 

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