Senior Government Programs Regulatory Specialist

About AbleTo

Join our mission-driven organization, where your work matters and a diversity of ideas and backgrounds are welcomed. AbleTo is the leading provider of high quality, technology-enabled behavioral health care. We believe that everyone deserves access to high-quality care and offer a suite of technology-enabled services to empower people to lead better lives through better mental health. A proprietary platform connects individuals with AbleTo highly trained licensed providers who deliver weekly sessions by phone or video supported by an integrated digital experience. Members also have access to mental health coaches, and digital support programs. Our outcomes-focused approach is proven to improve both behavioral and physical health and lower medical costs.

Overview

The Senior Government Programs Regulatory Specialist is responsible for tracking mission-critical federal and state regulatory requirements for AbleTo’s Medicare and Medicaid lines of business. The Senior Government Programs Regulatory Specialist researches, identifies, analyzes, and serves as the subject matter expert for relevant new and updated statutory and regulatory requirements related to Government Programs (e.g. Medicare, Medicaid). The Senior Government Programs Regulatory Specialist effectively translates complex regulations and educates internal and external customers on compliance requirements and their implications. She/he assesses compliance and business risk and provides regulatory compliance consulting to support business solutions. 

Strong analytical and communication skills are required to ensure business areas have processes and guidelines in place to comply with applicable State and Federal laws and regulations for Medicare and Medicaid. The specialist will interface with operational departments to ensure awareness of and compliance with these requirements. The specialist will identify relevant regulations based on business initiatives and maintain a repository of requirements related to: 

• Medicare Advantage 
• Medicaid (by State)

What You’ll Do: 

• Maintain up-to-date knowledge on federal and state by state regulatory requirements that may impact AbleTo’s Managed Medicaid and Medicare Advantage business;
• Analyze requirements for Medicaid group enrollments and assist with implementations to support anticipated/projected business growth 
• Assist with research and recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements
• Coordinate with Compliance, operations team members and third parties/compliance vendors on product changes and regulatory notification/approval requirements
• Assist in maintaining regulatory databases and summary reports to support management efforts to track and trend filing requirements 
• Provide responses to clinical and other teams that need state regulatory input as questions/concerns arise
• Perform up-to-date research related to coding requirements and provide guidance to the appropriate teams;
• Assist the Sr. Director, Compliance in managing, monitoring, and educating the organization to ensure compliance with internal policies 
• Assist with issue identification, maintenance of compliance logs (call center, provider, patient, client, internal concerns, etc.). Input information into compliance log tracking tool 
• Work collaboratively with operations teams to make appropriate recommendations to procedures and guidelines to ensure compliance with stated regulations
• Assist in the preparation of the annual work plan by reviewing State and Federal initiatives i.e., OIG work plan, NY OMIG Work Plan, etc.  
• Generate and maintain state by state requirements compliance checklist;
• Support the compliance team with managing filings/registrations, including drafting and compiling of technical files, documents and related submissions
• Represent Compliance Department in project meetings and provide regulatory guidance
• Assist the Sr. Director, Compliance in reviews and investigations of compliance issues or concerns within the organization to appropriately evaluate and resolve in a timely manner
• Perform other duties or special projects as assigned

Who You Are:  

• Bachelors required 
• Three to five years experience working with Medicare and Medicaid regulations, with an emphasis on Medicaid implementation
• Working knowledge of state and federal regulations, CMS, health plan, and health system requirements
• Working knowledge of medical coding guidelines, principles and requirements i.e., HCPCS, CPT, use of modifiers, etc.

Preferred Experience: 

• Project management experience 
• Experience working in regulatory and/or compliance functions 
• Must have ability to analyze data and make data-driven strategic decisions 
• JD or paralegal/compliance background - applying regulations to business practices 
• Policy background 
• Experience working in fast paced environments 

Competencies: 

• Excellent ability to maintain a high level of integrity and confidentiality
• Excellent verbal and written communication skills
• Strong ability to adapt and be flexible
• Excellent prioritizing, organizational, and interpersonal skills
• Excellent documentation skills including record maintenance/ tracking and understanding of document traceability
• Ability to work in a fast-paced environment, with multiple tasks/projects
• Ability to work in a Project Team Environment
• Google Suite proficiency (preferred)

Why You Should Join Our Team:

We’re proud to be a Great Place to Work-Certified™ company. We want you to show up and feel your best at work, and that means respecting your time outside of work. Our inclusive, flexible workspace prioritizes a work/life balance. We offer competitive salaries, comprehensive health benefits (for full-time employees), and professional perks such as 401K matching, fully funded HRA, and generous time off, including mental health days because your well-being is important to us. 

At AbleTo, we’re empowering people to get better and stay better. Want to join us? Take the next step in your career by applying for this role today. 

The salary range for this role is $60,000 to $110,000.  Pay is based on several factors including but not limited to education, work experience, certifications, etc.  In addition to your salary, AbleTo offers benefits such as a comprehensive benefits package, incentive and recognition programs, and 401k contribution (all benefits are subject to eligibility requirements).

#LI-Remote