Medicaid Compliance Analyst — Ensure Health Plan Compliance

CVS Health; Indianapolis (IN); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a compliance professional to support the Medicaid managed care compliance program. The role involves tracking regulatory deliverables, developing compliant processes, and coordinating audits within a health plan context.

You will work with the Compliance Officer and team to ensure timely responses to Medicaid inquiries and maintain essential policy and contract documentation. A Bachelor’s Degree and 2+ years in regulatory compliance are required.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance.
• Experience with Medicaid or Medicaid managed care is preferred.
• Project management experience is preferred.
• Audit experience is preferred.

Responsibilities

• Maintain systems and tools to track, monitor, review, and submit regulatory and compliance deliverables to state Medicaid agencies by due dates.
• Assist with research and recommendations to develop compliant business operations and policies per state Medicaid requirements.
• Develop compliant communications in response to state Medicaid agency inquiries or requests.
• Maintain working knowledge of contractual, regulatory, and program obligations of Medicaid managed care.
• Support external audit reviews, including project management and tracking of deliverables and corrective actions.
• Maintain contract libraries, regulatory reporting assignments, risk assessments, and internal reporting tools.
• Utilize systems and software (e.g., Microsoft products, Archer); train users and contribute to system enhancements.
• Support oversight to evaluate compliance levels and escalate risks when needed.

Skills

Regulatory compliance

Project management

Audit experience

Education

Bachelor's Degree

Tools

Archer

Job description

CVS Health is seeking a compliance professional to support the Medicaid managed care compliance program. The role involves tracking regulatory deliverables, developing compliant processes, and coordinating audits within a health plan context.

You will work with the Compliance Officer and team to ensure timely responses to Medicaid inquiries and maintain essential policy and contract documentation. A Bachelor’s Degree and 2+ years in regulatory compliance are required.