Medicaid Compliance Lead: Audit & Risk

CVS Health; Harrisburg (Dauphin County); On-site; USD 47,000 - 112,000; Full time

Job summary

CVS Health seeks a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across the organization. You will guide cross-functional teams to deliver timely, high-quality audit results and strengthen regulator relationships while implementing proactive risk mitigation.

Leveraging deep experience in compliance, analytics, and operations, you will standardize processes, optimize workflows, and ensure data integrity to support contractual obligations and

Qualifications

• Minimum of 3 years in audit, compliance, or related healthcare operations.
• Ability to develop and execute detailed project plans with accountability and rigor.
• Strong analytical skills to interpret data, identify trends, and suggest compliant solutions.
• Advanced proficiency in Microsoft Excel for data analysis and reporting.
• Excellent written and verbal communication with ability to influence across levels.
• Ability to lead initiatives, mentor teams, and thrive in a fast-paced environment while ensuring compliance.

Responsibilities

• Direct collaboration with internal teams and external auditors to deliver high-quality results and maintain compliance.
• Interpret audit findings to recommend corrective actions and process improvements.
• Respond to inquiries from internal stakeholders and regulators with accuracy and timeliness.
• Serve as a technical and functional leader, managing multiple compliance-related projects for timely execution.
• Oversee policy and procedural documentation development and timely annual reviews.
• Build cross-functional partnerships to influence compliant outcomes and strategic goals.

Education

Bachelor's degree

Bachelor's degree preferred

Tools

Microsoft Excel

Job description

CVS Health seeks a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across the organization. You will guide cross-functional teams to deliver timely, high-quality audit results and strengthen regulator relationships while implementing proactive risk mitigation.

Leveraging deep experience in compliance, analytics, and operations, you will standardize processes, optimize workflows, and ensure data integrity to support contractual obligations and