Regulatory & Provider Network Filing Analyst

MedPro Group; Springfield (MA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Life, health and dental insurance

401K retirement plan

Flexible spending account

Tuition reimbursement

Business casual dress

Job summary

MedPro Group is seeking a candidate for a compliance role focused on provider network regulations. Your responsibilities will include serving as a subject matter expert, implementing best practices, and overseeing network filings. The ideal candidate will have a Bachelor's degree in healthcare administration, compliance experience, and strong organizational skills.

With a competitive salary range of $60,000 to $80,000, this position also offers a comprehensive benefits package including health, dental, and retirement plans. Join us to make a significant impact in the healthcare insurance sector.

Qualifications

• 2+ years of health insurance experience or a combination of education and experience is required.
• Ability to interpret and apply state and federal laws and regulations.
• Strong organizational skills and the ability to manage competing priorities.

Responsibilities

• Serve as a subject matter expert in provider network regulations and accreditation requirements.
• Implement and enforce best practices and policies.
• Oversee network filings and ensure timely submissions.

Skills

Healthcare administration

Compliance experience

Network experience

MS Office proficiency

Excellent communication skills

Education

Bachelor’s degree in healthcare administration or related field

Tools

SERFF filing system

Job description

In this role you will…

• Serve as a subject matter expert (SME) in provider network regulations, accreditation requirements, network adequacy standards, and other new and existing laws pertaining to provider networks, guiding and advising across various business areas and activities, including internal and external stakeholders.
• Implement and enforce best practices and policies, ensuring alignment with department and organizational goals.
• Perform a detailed review of new legal and regulatory guidance to identify and implement any necessary changes.
• Track regulatory submission deadlines, and proactively coordinate with external and internal stakeholders to prepare filings in advance of deadlines.
• Oversee network filings and reports from inception to completion, ensuring that all submissions are accurate, well‑written, and timely.
• Regularly monitor open submissions to ensure timely and accurate responses to any objections or requests for additional information.
• Support the review and development of written responses for network submissions and responses to objections, as needed, and validate data to ensure accurate reporting.
• Ensure all regulatory filings and reporting deadlines are met.
• Implement and enforce best practices and assist with ad hoc projects to achieve departmental or organizational goals. Collaborate with internal and external stakeholders to perform network oversight, and develop and monitor corrective action plans, as needed.
• Perform other duties as assigned.

We are looking for candidates with…

• Bachelor’s degree in healthcare administration or related field, and 2+ years of health insurance experience or a combination of education and experience.
• Compliance and/or network experience preferred.
• SERFF filing system experience preferred.
• Ability to work effectively with internal and external stakeholders.
• Ability to interpret and apply state and federal laws and regulations.
• Familiarity with provider network regulations, accreditation requirements, and NCQA standards preferred.
• Excellent written communication and interpersonal skills.
• Strong organizational skills and the ability to manage competing priorities.
• Proficiency with MS Office products including Outlook, Word and Excel.
• Demonstrates a strong commitment to compliance and ethics.
• Self‑motivated with the ability to work independently, with very little supervisory direction.

Benefits

Wellfleet offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, 401K retirement plan, short‑ and long‑term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress.

General

Wellfleet is part of the MedPro Group family. As such, all Wellfleet team members are employees of MedPro Group Inc. We are an Equal Opportunity Employer. The annual gross base salary range is $60,000 to $80,000. This range anticipates the low and high end of the salary for this position. Actual salaries will vary and are based on factors such as a candidate’s qualifications, skills and competencies. Salary is one component of Wellfleet’s total compensation and benefits package, which includes medical, vision and dental insurance options, life and accident insurance, 401(k), and short‑term and long‑term disability insurance. For a more detailed overview, visit our careers website at: wellfleetinsurance.com/about/careers.