Regulatory Operations Analyst II - IDR Operations

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Support the Independent Dispute Process (IDR) under the No Surprise Act (NSA). Ensure compliance with NSA requirements by managing dispute resolution and providing key insights through research and reporting. Oversee the submission and tracking of offers, fees, arbitration rulings, and manage processes such as CMS withdrawal requests or CMS complaints. Additionally, the role includes performing legal and regulatory research and supporting broader departmental initiatives related to NSA law disputes.

• Oversee the end-to-end IDR process, ensuring compliance with regulatory timelines and requirements.
• Track arbitration ruling outcomes, ensuring accurate documentation and communication of decisions.
• Coordinate and process CMS withdrawal requests or submit CMS complaint as needed.
• Conduct detailed research on NSA related legal and regulatory updates, providing summaries and actionable insights to the team.
• Coordinate with legal and compliance teams to address complex regulatory issues.
• Develop and maintain reports tracking IDR activity, financial impacts, and dispute outcomes.
• Analyze trends and identify key insights to inform strategic decisions and process improvements.
• Collaborate with leadership to provide data visualizations and summaries for internal and external stakeholders.
• Identify inefficiencies or gaps in the IDR process and propose enhancements. Serve as the primary liaison between internal departments, providers, arbitrators, and regulatory bodies.
• Act as a subject matter expert (SME) for NSA-related questions and escalations.
• Ensure all IDR documentation is accurate, complete, and compliant with NSA guidelines.

Education/Experience:
Bachelor's Degree Business, Communications, Healthcare, Political Science/Pre-Law, MA/JD or related field or equivalent experience required. 2+ years regulatory experience, including policy analysis and/ or product filings (CMS and/ or State DOI) or related area required. Experience in commercial health insurance preferred. Experience with overseeing the end-to-end Independent Dispute Resolution (IDR) process preferred. AMISYS and SQL experience preferred.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act