Regulatory Affairs Compliance Manager

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Jan 13, 2025
Principal Duties and Responsibilities: Works closely and collaboratively with Strategy, Sales, and Product Teams within Mass General Brigham Health Plan to ensure compliance with federal and state regulations in support of the overall Business Strategy. Develops and maintains an efficient and effective means to manage on-going internal and external deliverables that will facilitate the business understanding of regulatory and compliance requirements. Functions as the Compliance Department/Subject Matter Expert on the following standing teams/items: Mental Health Parity; Connector/ACA Implementation; IRS Sec 6055/6056 Reporting; Annual Notice of Benefit and Payment Parameters. Manages the accurate submission of reports, filings (Licensing and Accreditation) and other deliverables required by the Division of Insurance or other regulatory agencies by performing quality checks to ensure completeness, accuracy, and uniformity. Facilitates cross-organizational compilation of responses to requests for information from regulatory agencies (CCIIO, CMS, DOI, CHIA), external auditors, and others by: oIdentifying necessary sources of information (Business Owners, data bases, internal information repositories) and identifying tasks and internal deadlines. oProviding guidance and assistance to Business Owners in fully understanding the request. oCommunicating with the requesting party to clarify the request and to establish reasonable expectations of deliverables. oCollecting and collating, in an organized manner, all information needed to completely satisfy the request. oReviewing all reports and documents to ensure consistency, completeness, and applicability to the request. Manages all aspects of assigned compliance work from scope definition through interpretation of regulation/guidance, implementation, and evaluation of results, following-up on time-lined deliverables, and developing and coordinating a unified response, as necessary. Partner with the business to identify, coordinate and manage internal/external team resources to achieve program objectives. Effectively participate on, and lead, cross-functional teams working within a matrix management environment. Manage and direct the work of team resources from multiple departments or external organizations (e.g., vendors, business partners, consultants, etc.). Communicate in multiple mediums to all levels of staff. Provide clear, concise, and timely information to key constituents regarding regulatory and compliance issues. Effectively plan and transition regulatory and compliance deliverables to day-to-day operations. Provide and cultivate effective meeting management skills and participation. Hold self and others accountable to meet commitments. Ensure diversity, equity, and inclusion are integrated as a guiding principle. Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. Other duties as assigned with or without accommodation. Qualifications:* * Master's degree in public health or related field required with knowledge of federal and state-based commercial regulatory environment, plus 5-7 years healthcare experience with 3+ years of experience in commercial insurance and healthcare compliance/regulatory affairs. * JD preferred. * 5+ years with broad-based knowledge of all aspects of Commercial Health Insurance preferred. Skills/Abilities/Competencies: * Strong interpersonal and communications skills, including written, verbal and presentation skills. * Excellent problem solving, analytical, planning, and organizational skills. * Ability to manage multiple projects, determine project urgency in a meaningful and practical way, use goals to guide actions and create detailed action plans, organize, and schedule people and tasks. * Ability to prioritize work and operate under tight deadlines. * Ability to effectively communicate with technical and non-technical team members. * Ability to work effectively to build consensus among a wide range of constituents and meet aggressive time schedules. * Ability to effectively organize, manage and facilitate meetings and develop and maintain work plans. * Ability to work independently and collaboratively. * Ability to mentor and coach others. * Self-motivation and flexibility. * Proficiency with Microsoft Office products. * Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value. * Bring fresh ideas forward by listening to and working with employees and the people we serve. * Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner. * Strong, demonstrated track record of an ability to execute on time, on budget, and on scope. * Strong aptitude for technology-based solutions. * Ability to inject energy, when and where it's needed. * Current in healthcare trends. * Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be." * Ability to develop, introduce, defend, and gain support for a new ideas and approaches. * Excellent leadership skills and leadership track record. * Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required. * Ability to view the long-range trends and cycles of the business and industry and see the "big picture." * Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions. * Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy. * Excellent interpersonal skills, including the ability to influence others at all levels of an organization. * Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. * Unquestionable integrity. Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. Physical Requirements Standing Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 50lbs Carrying Occasionally (3-33%) 20lbs - 50lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.