Medicaid Compliance Analyst: Regulatory Reporting & Audits

CVS Health; Richmond (VA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options (401k)

Wellness programs

Job summary

CVS Health in Richmond, VA is seeking a compliance professional to support the Medicaid managed care compliance program and promote ethical, compliant operations across our health plans.

Responsibilities include tracking regulatory deliverables, coordinating audits, and developing communications with Medicaid agencies while partnering with the Compliance Officer to mitigate risks and improve operations.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance.
• Bachelor's Degree required.
• Master's degree may substitute for work experience in relevant roles.

Responsibilities

• Maintain systems and tools to track, monitor, review, and submit required regulatory and compliance deliverables to state Medicaid agencies by due dates.
• Assist with research and recommendations to develop compliant business operations per Medicaid program requirements.
• Develop compliant communications in response to state Medicaid inquiries or requests.
• Maintain knowledge of contractual, regulatory and program policy obligations as a Medicaid managed care organization to educate staff.
• Support external audit reviews by coordinating deliverables and corrective action plans until closure.
• Maintain internal tools and resources (contract library, risk registers, reporting systems) for oversight of compliance processes.
• Utilize system tools (Archer; MS Office) and contribute to system design, maintenance and user training.

Skills

Regulatory compliance

Managed care

Education

Bachelor's Degree

Tools

Archer

Microsoft Office

Job description

CVS Health in Richmond, VA is seeking a compliance professional to support the Medicaid managed care compliance program and promote ethical, compliant operations across our health plans.

Responsibilities include tracking regulatory deliverables, coordinating audits, and developing communications with Medicaid agencies while partnering with the Compliance Officer to mitigate risks and improve operations.