Kaiser Permanente Lead Analyst, Regulatory & Policy - Atlanta in Atlanta, Georgia
The Lead Regulatory Analyst is responsible for leading the Dept's activities related to the Federal Employees Health Benefits Plan & the Medicare/CMS products & offerings. This position serves as the primary contact w/Program Office, Pricing & Underwriting & Account Mgmt to respond to Office of Personnel Mgmt (OPM) & the Centers of Medicare & Medicaid Srvs (CMS) regarding federal government product offerings. The Lead Analyst will also assist w/benefit interpretation & implementation activities due to legislative actions & develop implementation plans for new legislation affecting benefits & other new or changed benefits. As the Lead Analyst, assist to make decisions regarding requests for non-clinical benefit exceptions for new group sales & member specific issues. Additionally, the Lead Analyst will serve as backup to liaison w/the staff at the Georgia Dept of Insurance (DOI) including benefit interpretation, writing, editing, proofing, gaining internal approval, filing, responding to objections, obtaining regulatory approval, & ensuring accuracy of the issue version of KP's policy documents, in accordance w/applicable regulations & in a framework that supports the region's strategic product initiatives. This position involves a high degree of collaboration w/Compliance Office, Pricing, Marketing Communications, Product Development, Benefit Implementation, Sales & Marketing, Program Office Legal, Operations, & other internal & external teams & customers.
Essential Functions: - Responsible for leading the Dept's activities related to the annual Federal Employees Health Benefits (FEHB) plan renewal & the annual Medicare products renewal w/Centers for Medicare & Medicaid Srvs (CMS). Responsible to represent KPGA in the collaboration w/Program Office & all KP regions in the strategy development to support the responses to CMS including the accurate & timely completion of the Plan Benefit Package (PBP) & the Sr Advantage EOC. Serves as the primary contact w/Program Office, Pricing & Underwriting & Account Mgmt to respond to OPM & CMS regarding federal government product offerings. Responsible to represent KPGA in the collaboration w/Program Office & all KP regions in the strategy development to support the responses to OPM including the accurate & timely completion of the Benefit Change & Clarifications Worksheets & the Federal Brochure. Engages others in KP as subject matter experts to gain input & acceptance of changes in CMS/OPM submission documentation. Collaborates w/benefit implementation staff & others to understand the changes. Reviews,proofs,edits, & otherwise engages w/Marketing Communications to ensure accuracy & consistency of marketing supplemental materials w/Medicare Sr Advantage EOC & supporting policy documents for CMS & OPM. Responsible for maintaining desk top manual & training of all functions performed w/in this position. - Identify & develop plans for communication to, & education of, providers & other regional personnel about benefits & coverage issues. Coaching/Mentoring-Serves as a coach & mentor to other staff of Policy & Regulatory team & facilitates skill development & advancement of learning for other team members. Demonstrates an understanding of the industry & organizational environment & its impact on objectives. Prepare updates & reports to leadership on submissions status, potential budget impacts (evaluate for cost savings), & benefit exception volume (& identify ways to decrease). Demonstrate leadership & strategic orientation for Enterprise or Compliance initiatives that impact Policy & Regulatory (Commercial, Feds & Medicare) to ensure accuracy, completion & documentation.
Qualifications: Basic Qualifications: Experience - Minimum seven (7) years of relevant health care industry experience. - Minimum five (5) years of project management experience. Education - Bachelor's degreeOR four (4) years ofexperience in a directly related field. - High school diploma or GED required. License, Certification, Registration - N/A
Additional Requirements: - Demonstrated ability to manage multiple priorities working in a fast paced environment under intense deadlines. - Strong communication and interpersonal skills. - Strong organization and planning skills. - Strong results orientation and influence skills.
Preferred Qualifications: - Minimum two (2) years of experience working with one of the region's benefit systems/applications (CM, Epic). - Document management software experience. - Master's Degree from accredited university/college in healthcare administration or related field. - Health insurance license in state of Georgia. - Project Management certification.
COMPANY Kaiser PermanenteTITLE Lead Analyst, Regulatory & Policy - AtlantaLOCATION Atlanta, GAREQNUMBER 624672
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.