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Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Fargo Health Plan
Location: Fargo, ND
Address: 1749 38th St S, Fargo, ND 58103, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
This is an exciting opportunity to join the growing Government Programs team at Sanford Health Plan!
Monitors a broad portfolio of regulatory systems and initiatives to enable organizational compliance with all applicable federal, state and local laws and regulations. Possesses a high level of focus and strong attention to detail while working with constantly changing forms, templates, grids and consumer-facing material.
Stays abreast of all federal and state regulations and guidance. Possesses the ability to understand complex, regulated workflows and guidance in order to implement basic administrative support for operations. Consistently manages multiple projects at varying stages of completion. Easily prioritizes and adjusts to constantly changing regulations and project needs. Ensures product filings are always professional, accurate and timely.
Properly completes plan documents, such as Summary of Benefits and Coverage (SBCs), Certificates of Insurance (COIs), member applications and other documents as assigned, according to federal and state requirements. Reviews and ensures relevant documents and other necessary files are in accordance with privacy and security regulations as well as government program regulations. Ensures all plan documents and member benefits are aligned with regulatory requirements and business decisions. Reviews and ensures relevant documents and other necessary files are in accordance with HIPAA.
Works closely with compliance staff and legal counsel to create and maintain required legal documents and submit documents for state and federal product filings accordingly. Provides impending legislation impact analysis that would be needed to meet regulatory compliance.
Utilizes applicable Centers for Medicaid and Medicare Services (CMS) review and validation tools (i.e. Data Integrity Tool (DIT)) for QHP filing templates and product form filing checklists. Performs all issuer testing of pre-published products and runs sample scenarios to ensure products display as planned, including Healthcare.gov plan preview reviews, to validate product benefit structures are consistent with plan designs and compliant with federal and state regulations
Will also undertake special projects as assigned.
Bachelor’s degree required. Leadership will accept an associate degree with a minimum of six years' experience in lieu of bachelor's degree.
Experience in one of the following is preferred: public policy, health policy, compliance, banking regulations
Preferred experience using document control software. Proficient in Microsoft Office, Excel, Word, OneNote and Adobe.
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to email@example.com .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Job Function: Health Plan
Req Number: R-67679