Job Description
About the position
The Healthcare Review/Audit Policy Member is responsible for monitoring federal/state policy changes and court rulings relevant to the Exchanges (e.g., changes impacting the Advanced Premium Tax Credit (APTC)/Qualified Health Plan (QHP) eligibility, and Special Enrollment Periods (SEPs), and through reviewing annual Exchange regulations, sub-regulatory guidance, and system/operations documentation; Assesses the impact of those changes on Exchange Improper Payment Measurement (EIPM) methodology, including review unit logic, scripts, and review tools, and determines where updates are required; Develops policy update deliverables and coordinates with technical, review, and data teams to accurately reflect changes.
- Responsibilities
- Monitoring federal/state policy changes and court rulings relevant to the Exchanges
- Reviewing annual Exchange regulations, sub-regulatory guidance, and system/operations documentation
- Assessing the impact of changes on Exchange Improper Payment Measurement (EIPM) methodology
- Determining where updates are required for review unit logic, scripts, and review tools
- Developing policy update deliverables
- Coordinating with technical, review, and data teams to accurately reflect changes
- Requirements
- Bachelor’s degree
- 3-5+ years of relevant experience
- Experience working in or knowledge of the Affordable Care Act, specifically State-Based Exchanges, Federally-Facilitated Exchanges, and health insurance markets and exchanges
- Ability to oversee multiple concurrent workstreams
- Excellent communication skills (verbal and written)
- Strong stakeholder management skills and experience
- Nice-to-haves
- Experience with regulatory analysis
- Ability to navigate ambiguity and provide clear guidance, direction, and structure to the team
- Flexibility and agility to respond to changing requirements in a dynamic environment
- Skills to develop training on regulatory updates and train team members on the impact of the changes
- Proficiency working with compliance team members and developers to confirm that regulatory changes are properly reflected in testing methodology and automation scripts
- Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
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