Medicaid Compliance Analyst

CVS Health; Montgomery (AL); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a career-level compliance professional to support the compliance program for a Medicaid managed care organization. You will develop systems and processes that promote compliant and ethical behavior across our Medicaid health plans.

Responsibilities include tracking regulatory deliverables, researching compliant operations, and maintaining knowledge of contractual obligations to support decision making. This full-time role offers comprehensive benefits.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance.
• Bachelor's degree in a related field required; Master’s considered a plus.

Responsibilities

• Maintain systems to track, monitor, review, and submit regulatory deliverables to state Medicaid agencies.
• Assist with research and recommendations to develop compliant business operations per Medicaid requirements.
• Develop communications for Medicaid agency inquiries or requests.
• Maintain knowledge of contractual, regulatory, and program policy obligations for Medicaid managed care.
• Support external audit reviews with project management of deliverables and corrective action plans.
• Maintain internal tools and contract libraries for compliance oversight.
• Use standard software and compliance tools (e.g., Archer) and train users.
• Elevate risks and issues through appropriate channels with business partners.
• Foster productive relationships to promote ethical and compliant outcomes.

Skills

Regulatory compliance

Medicaid knowledge

Regulatory reporting

Education

Bachelor's Degree

Tools

Archer

Microsoft Office

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

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 and other team members, 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 basic regulatory reports as needed on behalf of the Medicaid compliance team
• Assist with research and recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements
• Develop compelling and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests
• Maintain 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 purposes
• 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 processes
• Utilize 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 maintenance
• In partnership with other senior members of the team, support oversight and monitoring activities 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 elevate risks, concerns and other issues through appropriate channels
• Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes
• Other duties as assigned

Required Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance; or a Master's degree.

Preferred Qualifications

• Experience with Medicaid or Medicaid managed care
• Project Management experience
• Audit experience

Education

• Bachelor's Degree

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $102,081.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.