Medicaid Compliance Analyst — Regulatory & Audit

CVS Health; Pierre (SD); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a career-level compliance professional to support the Medicaid managed care organization’s program activities and deliverables. You will track regulatory items, develop compliant processes, and prepare communications with state Medicaid agencies while partnering with the Compliance Officer and team.

Responsibilities include maintaining tools and systems, supporting external audits, and ensuring ongoing education on contractual and regulatory obligations.

Qualifications

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

Responsibilities

• 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

Skills

Regulatory compliance

Managed care

Healthcare

Insurance

Project management

Audit

Education

Bachelor's Degree

Tools

Archer

Microsoft Office

Job description

CVS Health is seeking a career-level compliance professional to support the Medicaid managed care organization’s program activities and deliverables. You will track regulatory items, develop compliant processes, and prepare communications with state Medicaid agencies while partnering with the Compliance Officer and team.

Responsibilities include maintaining tools and systems, supporting external audits, and ensuring ongoing education on contractual and regulatory obligations.