Manager Health Insurance Compliance

We are a Third-Party Employee Benefits Administration and Consulting Firm in the Philadelphia/South Jersey area actively recruiting a Manager, Health Insurance Compliance to assist with servicing several of our New Jersey and New York Health and Welfare Fund clients. Our client base is Multi-employer, Taft-Hartley, collectively bargained Employee Benefit Funds.

POSITION QUALIFICATIONS:
Education (Minimum Needed): Bachelor’s degree or equivalent work experience.
3 to 5 years health benefits experience | Health Insurance Compliance experience preferred.

Specialized Knowledge Needed for Performance of Job:
Moderate exposure to Federal Health Care Compliance laws and regulations, e.g., the Affordable Care Act, the Consolidated Appropriations Act, Mental Health Parity as well as applicable State laws and regulations; experience dealing with the Taft Hartley fund administrative environment; exposure to Collective Bargaining Agreements (CBAs).

Special Skills: A self-starter, who can work independently; one who can analyze a problem from both a strategic and tactical perspective and is decisive in pursuing the resulting course of action; someone with the ability to establish relationships with fund administrative personnel (given competing priorities) to ensure timely Health Insurance Compliance; a person with the ability to handle multiple projects in a timely manner from beginning to end – with the ability to deliver the expected results; one geared to pragmatic solutions; proficient with Microsoft Word, Excel and Outlook; a person comfortable with timely documentation of compliance decisions and activities; an individual with good oral and written communications skills – including ability to write and/or communicate timely, accurate and effective Health Care Compliance responses to Fund Administrative personnel, as well as Fund Counsels. Well organized to effectively handle paper and electronic documents and communications associated with Health Insurance Compliance

ESSENTIAL FUNCTIONS:
Stay up to date regarding ACA/HCC scope and details. Stay abreast of developments through BenefitsLink and involvement with the Manager, Health Care Compliance. Annually work with applicable client funds to update and maintain Summary of Benefits and Coverages (SBCs):

• Ensure that the SBCs reflect the latest HCC regulatory developments;
  
• Update Coverage Examples, if applicable;
  
• Review SBC drafts plan design changes and updates;
  
• Ensure the SBC drafts have no HCC regulatory issues;
  
• Provide the client funds with the final SBCs on a timely basis to ensure distribution to plan participants in advance of the mandated dates, i.e., 30 days prior to the start of the plan year;
  
• Develop SBCs for new client funds and plans; Maintain SBC Dropbox database.
  
• Assist with the IRS annual §6055 & §6056 Affordable Care Act (ACA) Reporting for our company and client funds and applicable state(s), e.g., review & implement annual IRS form modifications; IT coordination; billing documentation; draft workflow documents, draft and circulate fund communications and monitor fund compliance.
  
• Assist with gathering data and filing Gag Clause Prohibition Compliance Attestation and Prescription Drug Data Collection report.
  
• Responsible for data retention of ACA filings, annual SBCs, HCC Dropbox database, etc. Monitor and document U.S. Preventive Services Task Force (USPTF) final recommendations re: fund impact and confirm vendor compliance.
  
• Draft and submit ACA/HCC Fund Status Reports for applicable funds for inclusion in Trustee Meeting books. Documents provide Fund Trustees with an overview of responses to ACA/HCC-related developments.
  
• Track annual ACA-mandated increases in out-of-pocket maximums (MOOPs). Coordinate with the applicable Funds to communicate and verify implementation by Medical Service Providers (MSPs) and Prescription Benefit Managers (PBMs).
  
• Assist in the drafting and distribution of HCC Benefit Briefs.
  
• Prepare Marketplace notices for inclusion in new hire packets; prepare Affordability Notices for applicable funds/employer and maintain HCC documentation.
  
• Responsible for client on boarding: Review health plans for compliance and produce SBC drafts. Prepare key deliverables list and key dates; Draft health plan comparison charts, as needed.
  

ADDITIONAL RESPONSIBILITIES:

• Confer regularly with Manager, Health Care Compliance to review Health Care Compliance-related project activity, assignments, and objectives.
  
• Other responsibilities, which may be assigned from time to time by the Director or Manager, Health Care Compliance, or another Company Executive.
  
• Record HCC-related billing hours and communicate same to the Director and Manager, Health Care Compliance and the applicable funds on a monthly basis.
  

SALARY RANGE: $90,000 - $95,000

We offer a very competitive compensation package, comprehensive health coverage, defined benefit pension plan, 401(k) plan and generous paid time off. If you meet the requirements for this position, please forward a cover letter and resume to this site.

To Apply
Please send responses via e-mail referencing Job: 14467 to [email protected]. Your resume will be forwarded