Medicaid Compliance Analyst: Regulatory Operations

CVS Health; Lansing (MI); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health is seeking a Career level compliance professional to support the compliance program for Medicaid managed care operations. You will help design, maintain, and implement compliant processes and deliverables across the health plan.

Responsibilities include tracking deliverables, advising on policy implementation, preparing regulatory responses, and supporting internal and external audits. A Bachelor's degree is required, with 2+ years of relevant experience.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance; or a Master’s degree.
• Experience with Medicaid or Medicaid managed care is preferred.
• Project Management and Audit experience are preferred.

Responsibilities

• Maintain systems/tools to track, monitor, and submit regulatory/compliance deliverables to state Medicaid agencies on or before due dates; prepare basic regulatory reports.
• Assist with research to develop compliant business operations and policies per state Medicaid requirements.
• Develop compliance communications in response to Medicaid agency inquiries.
• Maintain knowledge of contractual, regulatory, and program policy obligations for Medicaid managed care.
• Support external audit review processes with project management and corrective actions.
• Maintain internal tools and systems to ensure monitoring and oversight of compliance processes.
• Train users of systems and contribute to system design/maintenance.

Skills

Regulatory compliance

Healthcare knowledge

Education

Bachelor’s Degree

Tools

Archer

Microsoft Office

Job description

CVS Health is seeking a Career level compliance professional to support the compliance program for Medicaid managed care operations. You will help design, maintain, and implement compliant processes and deliverables across the health plan.

Responsibilities include tracking deliverables, advising on policy implementation, preparing regulatory responses, and supporting internal and external audits. A Bachelor's degree is required, with 2+ years of relevant experience.