Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Lead Regulatory Compliance Associate

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Regulatory and Compliance
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2012S Requisition #
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Summary of Job:
Implements, continually assesses and improves the Regulatory Compliance Program.
Addresses regulatory related inquiries escalated by the Medicare Regulatory Operations and Communication (MROC) team. 
Produces regulatory resources in order to assist Product Regulatory Operations and the business areas in understanding regulatory requirements and regulatory scheme.   
Develops and maintains key relationships with internal and external (State and Federal agencies as required) areas to maximize effectiveness of the Regulatory Compliance Program.  
Works closely with Regulatory Compliance Directors and VP, as well as with business area leadership regarding regulatory requirements and standards and the effective, measurable implementation of the Compliance program.  

Requirements:
  • Work with Director in designing and implementing an effective compliance program that meets regulatory requirements; including orchestrating the ongoing risk assessment process, coordination of reporting and activity related to various Compliance Committees; ensuring the Regulatory Compliance Plan remains up to date.
  • Executes activities in the Compliance Workplan, including ensuring that compliance reviews and audits are well designed and timely and efficiently conducted and coordinates responses and corrective actions in response to any identified incidence of non-compliance
  • Supports business areas by conducting regulatory research and compliance risk analyses.   Participates in business process improvement efforts and compliance improvement initiatives, as well as communicates with business leadership regarding events, training, and processes related to Regulatory compliance initiatives.
  • Assists in the development and improvement of the infrastructure of the Compliance program and day to day compliance activities. Ad hoc projects as assigned by the Regulatory Compliance Director.  
  • Regular attendance is an essential function of the job.  Performs other duties as assigned or required.

Qualifications:
  • Minimum 5-8 years’ relevant experience, preferably in health care 
  • Bachelor’s degree required, Graduate degree in health, law or business administration preferred
  • Experience in implementing an effective compliance program 
  • Demonstrated ability to interact with management, staff and regulatory agencies
  • Experience with Government Sponsored programs or regulatory and governmental affairs preferred 
  • Auditing experience preferred
  • High proficiency in Microsoft Suite of products preferred
  • Strong leadership skills with the ability to effect change and influence others 
  • Strong written and verbal communication skills and ability to effectively communicate with all levels of management
  • Identifies and recommends solutions to complex compliance issues within the parameters of the regulatory requirements 
  • Ability to identify, comprehend and relay relevant laws and regulations
  • Ability to work independently on complex issues
  • Excellent database and report preparation skills
  • Develop, maintain and execute all aspects of the organization’s compliance program 
  • Independently leads initiatives that improve organizational compliance in a highly complex regulatory and environment

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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