Medicaid Compliance & Regulatory Specialist

CVS Health; Columbia (SC); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid Time Off

Retirement Savings

Job summary

CVS Health is seeking a career level compliance professional to support the regulatory program for a Medicaid managed care organization in Columbia, SC. You will help develop and maintain systems to demonstrate an effective compliance program and promote ethical behavior across the health plan.

Responsibilities include tracking and submitting regulatory deliverables, researching compliant operations, drafting communications to state Medicaid agencies, and supporting audits and risk assessments.

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 experience and Audit experience are preferred.

Responsibilities

• Maintain systems to track, monitor, review, and submit regulatory and compliance deliverables to state Medicaid agencies.
• Assist with research to develop compliant business operations and policies per Medicaid requirements.
• Develop compliance communications in response to Medicaid inquiries or requests.
• Maintain knowledge of contractual, regulatory, and program obligations of Medicaid managed care.
• Support external audit processes and manage deliverables and corrective action plans.
• Maintain internal tools and systems for monitoring compliance processes.
• Train users, contribute to system design and maintenance of compliance tools.
• Elevate risks and concerns through appropriate channels.
• Build positive relationships with internal and external stakeholders.

Skills

Regulatory compliance

Project management

Audit experience

Education

Bachelor's Degree

Tools

Archer

Microsoft Office

Job description

CVS Health is seeking a career level compliance professional to support the regulatory program for a Medicaid managed care organization in Columbia, SC. You will help develop and maintain systems to demonstrate an effective compliance program and promote ethical behavior across the health plan.

Responsibilities include tracking and submitting regulatory deliverables, researching compliant operations, drafting communications to state Medicaid agencies, and supporting audits and risk assessments.