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 Specialist

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Manager & Professional
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210B6 Requisition #
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Execute the day to day operations of the Regulatory Compliance program, including the dissemination of new and revised regulatory guidance, maintaining and updating centralized monitoring of regulatory requirements, and supporting business units with the interpretation and execution of regulatory requirements. Support the organization by continually assessing day to day operations, policies and procedures and facilitating process improvement to meet Enterprise regulatory compliance expectations.   

 

Responsibilities:

  • Support business units by collaboratively facilitating the development of processes and procedures to ensure regulatory compliance, including conducting regulatory research to address department inquiries, participation in business process improvement efforts and compliance improvement initiatives, as well as communicating with business leadership regarding events, training, and processes related to regulatory compliance initiatives.
  • Summarize all incoming regulatory guidance, distribute to key stakeholders, upload to the centralized Online Monitoring tool and assign to the appropriate Regulatory Implementation Lead within the appropriate Product Department (Medicare, Medicaid, Commercial Product).
  • Monitor implementation of regulatory guidance by Product Departments. 
  • Review all documentation evidencing implementation for completeness and approve for closure. 
  • Support business areas in creating and updating key performance indicators.
  • Monitor regulatory compliance by reviewing key performance indicators, including maintaining a documented process.

Qualifications:

  • Bachelor’s degree required
  • Minimum 5-8 years’ relevant experience, preferably in health care (R)
  • Experience in implementing an effective compliance program (R)
  • Demonstrated ability to interact with management, staff and regulatory agencies(R)
  • Experience with government sponsored programs or regulatory and government affairs preferred (P)

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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