Manager, Regulatory Affairs

Manager, Regulatory Affairs

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular work onsite at the VIVA HEALTH corporate office and some work-from-home opportunities.   

Job Summary

The Manager, Regulatory Affairs will lead the organization’s efforts to ensure compliance with employer group health plan (commercial) regulatory requirements. This individual will collaborate across business units working closely with Clinical, Commercial Sales, Account Services, and administrative leaders to meet regulatory and strategic objectives and maintain compliant commercial products.

This position serves as a point of contact for federal and state officials and regulators, a resource to commercial employer groups regarding regulatory requirements and benefit changes, and representative to the organization’s trade groups regarding commercial regulatory requirements and proposals. This individual is responsible for the development and implementation of the company’s response to commercial regulatory requirements. This role requires a highly versatile leader with extensive knowledge of commercial health insurance regulations.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Key Responsibilities

• Manage the activities of the department including leading internal efforts to comply with regulatory requirements affecting the commercial line of business, including rules related to the Affordable Care Act, Mental Health Parity and Addiction Equity Act (MHPAEA), Transparency in Coverage and No Surprises Act, and ERISA.
• Lead or oversee required reporting to state and federal regulators related to the company’s commercial products. This includes scheduling, compiling, verifying, and submitting aggregated medical and pharmacy data, employer group data, information about the company’s small group products, and other required reporting to regulatory authorities.
• Oversee updates to the company’s mental health parity analyses, ensuring compliance with regulatory and sub-regulatory guidance related to MHPAEA.
• Oversee commercial regulatory activities including preparation for audits and ensure that corrective actions are implemented and sustained. Identify potential process, control, and compliance gaps. Implement strategies and lead initiatives to remedy identified issues and mitigate associated risks.
• Serve as a liaison with regulatory agencies maintaining positive relationships and advocating for VIVA HEALTH’s practices, policies, coverage, and standards.
• Effectively communicate relevant guidance to internal and external clients and stakeholders. Serve as the subject matter expert in the commercial regulatory environment. Draft corporate response to proposed rules and regulations.
• Develop and execute departmental policies and procedures. Lead the business continuity efforts for the department to ensure reporting and other requirements are met. This involves creating processes for cross-training and contingency planning.
• Develop and lead training programs to educate staff and leaders on regulatory standards and commercial benefits, emphasizing the importance of compliance in achieving high-quality care and cost containment.
• Review and ensure accuracy of all commercial plan documents and benefits communications.

REQUIRED:

• Bachelor's degree 
• 5 years’ experience in the health insurance industry
• 5 years' experience with compliance or regulatory affairs
• 3 years' experience in a supervisory or leadership role
• Strong critical thinking, time-management, and organizational skills
• Ability to read, analyze, and interpret governmental regulations and regulatory guidance and develop necessary action plans
• Ability to integrate diverse objectives with a high level of attention to detail
• Strong analytical skills, with experience in data-driven decision-making
• Ability to identify problems, collect and analyze data, establish facts, and draw valid conclusions
• In-depth knowledge of the industry’s legal rules and guidelines such as the Affordable Care Act, ERISA, COBRA, Mental Health Parity, No Surprises Act, and price transparency regulations
• Advanced interpersonal and formal communication skills, both written and verbal, with the ability to effectively collaborate with senior leaders, employees from all departments, employer clients, and regulatory agencies
• Ability to effectively present information and be persuasive in both individual and group settings, maintaining favorable public relations while remaining sensitive to a variety of cultural, social, and educational backgrounds
• Self-motivated with the ability to work independently or as part of a team
• Proficient with PowerPoint, Word, and Adobe Acrobat Pro
• Advanced Excel skills

PREFERRED:

• Relevant Master’s degree in health policy, public policy, health administration, public administration, or other related discipline and/or juris doctorate degree
• 10 years' experience in the health insurance industry
• 5 years’ experience in the commercial or individual managed care health insurance industry
• 5 years' experience in a supervisory role
• Certification in Healthcare Compliance (CHC) or similar credentials
• Strong project management skills with experience managing multiple complex regulatory projects and initiatives
• Lean Six Sigma