Regulatory Specialist, New York, NY

Created 06/09/2021
Reference 1079742
Job type Full Time
State NY
City New York
The Regulatory Specialist is responsible for overseeing member correspondence being sent is in compliance and acts as a liaison between stakeholders in Clinical business areas, as well as external vendors. As a member of the Clinical Regulatory and Compliance Operations team the Specialist must understand key regulatory and compliance processes and regulations. As well as adherence to the company's ethical standards while also conforming to all relevant federal, state and local laws, rules and regulations.

  • Ensure data accuracy for clinical member correspondence
  • Identify potential risk areas and analyze, evaluate and recommend changes and enhancements to existing practices, processes and controls
  • Act as a liaison to the Business Relationship Managers (BRMs), Regulatory, Compliance and other key stakeholders.
  • Identify area of improvements to enhance business efficiencies and to reduce risks
  • Maintain up-to-date knowledge about audit tools and techniques
  • Ensure that files are reviewed and stored in the department's audit repository
  • Prepare accurate and well-written audit reports summarizing audit observations, error trends, departmental and/or company risk, and recommendations to operations leadership
  • Additional duties as required or assigned

Minimum Qualifications:
  • Associates degree from an accredited institution or equivalent work experience
  • Work experience with audit methodologies and techniques
  • Knowledge of at least two or more lines of business such as Medicare, Medicaid, Essential Plan, Quality Health Plan, Commercial, etc.

Preferred Qualifications:
  • Bachelor's degree
  • Relevant prior experience such as experience working at a managed care health plan, healthcare regulatory compliance experience, or healthcare QA experience
  • Time and project management, communication, critical/creative thinking, and problem-solving skills
  • Intermediate Outlook, Word, Excel, and PowerPoint skills including creating spreadsheets, pivot tables, queries, and formulas

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Employer Healthfirst Inc.

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