Government Programs Compliance Consultant - Remote

About the role

This position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines. Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely.

Responsibilities

• Evaluates Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations.
• Conducts monitoring and oversight activities, including universe and report reviews, operational meeting participation, and targeted reviews of high-risk areas to assess compliance effectiveness.
• Collaborates with compliance, operational, and other cross-functional teams to promote effective risk management and regulatory compliance.
• Performs other duties as assigned.

Requirements

• Bachelor’s degree and 3 years’ experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance, or risk management.
• Ability to communicate with and build relationships with internal business units.
• Build relationships with various external government agencies as well.
• Critical thinking, risk assessment, and mitigation.
• Verbal and written communication skills.
• Ability to work with minimal supervision.
• Organizational, analytical, and decision-making skills.
• PC proficiency to include Word, PowerPoint, and Excel.

Preferred Job Qualifications

• Government Programs Healthcare Compliance experience
• Risk Adjustment experience
• CHC / CRC preferred
• Working knowledge of CMS regulatory frameworks

Skills

• Strong understanding of Medicare Advantage regulations and CMS guidance.
• Excellent analytical and problem-solving skills.
• Effective communication and collaboration abilities.
• Proficiency in Microsoft Office Suite.

Benefits

Commensurate with experience.

Pay

$61,500.00 - $136,100.00 Exact compensation may vary based on skills, experience, and location.

Schedule

N/A

HCSC Employment Statement

We are an Equal Opportunity Employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. To learn more about available benefits, please click here.