Medicaid Compliance Consultant IV

About the role

This individual contributor is primarily responsible for conducting company compliance activities in collaboration with internal and external stakeholders. Responsibilities include developing compliance reports, conducting compliance investigations, coordinating implementation of compliance efforts, and assisting with regulatory compliance through monitoring regulatory changes.

Responsibilities

• Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities.
• Congducts company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts; providing insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Ambiguity/Uncertainty Management
  Attention to Detail
  Business Knowledge
  Communication
  Critical Thinking
  Cross-Group Collaboration
  Decision Making
  Dependability
  Diversity, Equity, and Inclusion Support
  Drives Results
  Facilitation Skills
  Health Care Industry
  Influencing Others
  Integrity
  Learning Agility
  Organizational Savvy
  Problem Solving
  Short- and Long-term Learning & Recall
  Teamwork
  Topic-Specific Communication
  Analytical Skills
  Compliance Management
  Cross Department Coordination
  Getting Work Done Through Others
  Negotiation
  Project Management
  Technical Communication
  Written Communication

Requirements

• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.
• Four (4) years experience in health plan compliance.
• Four (4) years experience in health plan operations.
• Three (3) years experience working cross-functionally across departments, functions, or business lines.
• Two (2) years project management experience.
• Two (2) years experience in a leadership role with or without direct reports.
• Master's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
• Certified in Healthcare Compliance (CHC) or other equivalent compliance certification.

Qualifications

• Health Care Industry
• Compliance Management
• Health Plan Compliance
• Health Plan Operations
• Project Management
• Ledership Role

Skills

• Health Care Industry
• Compliance Management
• Health Plan Compliance
• Health Plan Operations
• Project Management
• Ledgership Role

Benefits

N/A

Pay

N/A

Schedule

N/A