Why does the job exist?
The purpose of this position is to provide oversight of managed health care compliance associated with fully insured major medical health plans subject to the ACA, Patient Protection Act and all other applicable state rules and regulations. This position will also coordinate duties assigned under the Memorandum of Understanding with the New Mexico Health Insurance Exchange in implementing a state-based Exchange and will perform technical review of Managed Health Care Plans' grievance procedures and annual compliance submissions, ensuring compliance with state and, as applicable, federal regulatory and statutory requirements.
This position's compliance duties will include seeking and performing analysis on data provided by insurance companies on health care provider access, utilization of health care benefits, mental health parity, and other health care administration metrics.
This position will assist in providing reports, as necessary, in support of regulatory and policy decision-making.
How does it get done?
Perform compliance review of annual submissions of Network Access, Utilization Management, Prior Authorization, Continuous Quality Improvement, Cultural and Linguistic Diversity, Provider Contracts, Mental Health Parity, and Consumer Assistance compliance plans. Communicates with carriers.
coordinate duties assigned under the Memorandum of Understanding with the New Mexico Health Insurance Exchange in implementing a state-based Exchange
Perform compliance review of grievance procedures utilized by managed health care plans.
Research and stay current with Federal and State laws and regulations applicable to MHCPs compliance and appeals processes, including attendance of National Association of Insurance Commissioner calls.
Collect data and analyze data demonstrating compliance with managed health care laws including network access, utilization management, continuous quality improvement, mental health parity, prescription drug access, and preventive care access provisions.
Participate in discussions and help develop reports on regulatory and legislative policy matters involving managed health care plan oversight.
Who are the customers?
Office of Superintendent of Insurance leadership, staff, and the State of New Mexico insurance consumers.
Ideal Candidate
- Health insurance compliance experience
- Experience working in the public health arena
- Experience with contract compliance review
- Experience with application of statutes and regulations
- Excellent written and verbal skills
- Strong Microsoft Word skills
Minimum Qualification
Bachelor's degree in Business Administration and two (2) years of experience in investigations, regulation, policy, statutory, and/or contract compliance. Substitutions Apply. See Substitution Table below.
Substitution Table
These combinations of education and experience qualify you for the position:
|
Education |
|
Experience |
|
Education |
|
Experience |
1 |
High School Diploma or Equivalent |
AND |
6 years of experience |
OR |
High School Diploma or Equivalent |
AND |
6 years of experience |
2 |
Associate's degree in the field(s) specified in the minimum qualification |
AND |
4 years of experience |
Associate's degree or higher in any field |
AND |
6 years of experience |
3 |
Bachelor's degree in the field(s) specified in the minimum qualification |
AND |
2 years of experience |
|
|
|
4 |
Master's degree or higher in the field(s) specified in the minimum qualification |
AND |
0 years of experience |
|
|
|
Some tips only applying for state jobs–
- Do not copy and paste your resume with any bullet points. The system can’t read them and your application turns into wing-dings on our end.
- It may be easier to apply using the position number than the link.
- Feel free to upload your resume if you find that it will provide more coherent information than the application. They’re apparently letting us see those now.
- Make sure to upload any transcripts that are required.
- Hew closely to the job description in any describing your past work/educational experience. There are HR workers that screen applications and tell us who is “qualified” our own positions. They may not let us advance a candidate if they do not look sufficiently “qualified.”
- If you want to triple check your application’s eligibility, feel free to contact the state personnel office’s “Talent Acquisition Office” by calling one of the folks listed here - https://www.spo.state.nm.us/contact-us.aspx
Please visit our Careers site to review the job posting and complete your application.
Compliance Officer - A [OSI #10112574]
State of New Mexico
Albuquerque
DIRECTIONS:
- Click the link below to access our Careers site.
https://careers.share.state.nm.us/psp/hprdcg/EMPLOYEE/HRMS/c/HRS_HRAM_FL.HRS_CG_SEARCH_FL.GBL?Page=HRS_APP_JBPST_FL&Action=U&FOCUS=Applicant&SiteId=1&JobOpeningId=113560&PostingSeq=1
- Sign In to access your account. If you do not have an account, select the menu bar on the right, and click on New User to create an account.
- Review the job description and click Apply for Job to begin your application.
If you are a current employee with the State of New Mexico and have a SHARE ID, please sign into your SHARE account. Click on the Careers tile under Employee Self Service to search for the job posting and begin your application.