Senior Medicaid Compliance Analyst

Job DescriptionExperienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer, this position will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in our Medicaid health plans. Responsibilities include, but are not limited to: Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to state Medicaid agencies on or before required due dates; prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance teamConduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirementsDevelop compelling and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requestsMaintain an in-depth working knowledge of the health plan's contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education and business decision making purposesManage and support the external audit review process in conjunction with designated subject matter experts at the health plan, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure)Maintain current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools as needed to ensure the appropriate monitoring and oversight of health plan compliance processesUtilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenanceConduct oversight and monitoring to evaluate levels of compliance with Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channelsMaintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes Provide training and guidance to less experienced team members to accomplish goalsOther duties as assignedPay RangeThe typical pay range for this role is:Minimum: 43,700Maximum: 97,400Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications5+ years regulatory compliance position in managed care, health care, or insurance or 3 years with Masters Degree.Project Management - 3 yearsPreferred QualificationsExperience with Medicaid or Medicaid managed care Audit experiencePolicy and ProceduresEducationBachelor's DegreeBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2024-11-02