Senior Regulatory Specialist Medicaid / CHIP - JHP

Regulatory Specialist II

The Regulatory Specialist II is responsible for ensuring compliance with all state and federal regulatory requirements affecting Pennsylvania's HealthChoices (Medicaid managed care) and CHIP programs. This role serves as a key liaison with the Pennsylvania Department of Human Services (DHS), Office of Medical Assistance Programs (OMAP), Bureau of CHIP, and other oversight entities. This position is responsible for monitoring regulatory developments and policy changes, analyzing their impact on business operations, managing contract deliverables, and collaborating with internal stakeholders to operationalize requirements and maintain compliance with DHS and state mandates. The ideal candidate has a strong understanding of health insurance laws (e.g., ACA, HIPAA, CMS, state DOI regulations) and experience working with regulatory bodies.

Responsibilities include :

• Interacting with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Monitoring federal and state regulatory changes, analyzing operational impact and providing analysis for internal stakeholders, including internal training, dissemination and distribution of regulatory communications to affected business units.
• Interpreting contract requirements, working with cross-functional teams to advise on implementation of new programs and initiatives.
• Supporting new Medicaid / CHIP implementations and renewals, including participation in readiness and operational reviews, RFP responses, and annual redetermination cycles.
• Preparing and ensuring timely and accurate regulatory submissions, such as contract deliverables, policy updates, readiness review materials, and state-required filings.
• Collaborating with internal departments to ensure product benefits and communication materials meet requirements.
• Maintaining detailed documentation and tracking systems for regulatory correspondence, contract deliverables, deadlines, and filing status.
• Drafting and updating compliance policies and procedures specific to regulatory department.
• Assisting in internal training and awareness efforts, providing regulatory interpretation.
• Serving as a liaison between the company and regulatory agencies.
• Participating in internal policy development and review processes to ensure alignment with Pennsylvania Medicaid / CHIP rules and CMS guidance under 42 CFR Part 438.
• Serving as a subject matter expert (SME) for Pennsylvania-specific regulatory requirements and providing training and guidance to internal teams.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education and Experience Requirements :

Work Shift : Workday Day (United States of America)

Worker Sub Type : Regular

Employee Entity : Health Partners Plans, Inc.

Primary Location Address : 1101 Market, Philadelphia, Pennsylvania, United States of America

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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