Provider Network Regulatory/Filing Supervisor - The MH Group

The ideal candidate will have experience in the health insurance industry, specifically in interpreting and applying managed care state and federal laws and regulations to daily operations. The candidate should be familiar with PPO network operations and the oversight of policies and procedures. A solid ability to meet deadlines is essential.

Responsibilities:

• Collaborate with the Provider Network Manager and regulatory staff to ensure all provider network adequacy, managed care, and accreditation regulatory filings and reports are complete and submitted by state and federal deadlines.
• Under the guidance of the Provider Network Manager, oversee the daily work of regulatory and filing analysts and specialists. Manage timesheets and time off requests.
• Train, coach, and conduct one-on-one meetings with provider network regulatory and filing staff.
• Oversee and assist with coordinating new and revised regulations affecting provider networks, ensuring alignment with internal carrier and PPO network policies and procedures to meet regulatory requirements.
• Analyze regulations, understand their impact on current organizational processes or procedures, identify necessary changes, and implement those changes.
• Maintain a regulatory tracking calendar and state grid to monitor compliance and revisions needed in policies and procedures.
• Engage in strategic planning to ensure all regulatory tasks are completed promptly.
• Manage and assist with state accreditation and re-accreditation filings, managed care filings, and state and federal regulatory reports.
• Coordinate and complete new and revised regulations, tracking them in the RegEd system.
• Participate in internal regulatory oversight meetings with internal departments and external calls with PPO networks and vendors to ensure regulatory compliance.
• Monitor and calculate provider team regulatory key performance metrics (KPMs).
• Assist the Provider Network Manager with ad-hoc projects that support the provider network and benefit the company as a whole.
• Perform other duties as assigned.