Medicaid Compliance Specialist

CVS Health; Concord (NH); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a career level compliance professional to support the Medicaid managed care compliance program, reporting to the Compliance Officer and team. You will help develop and maintain systems and processes that demonstrate the principles of an effective compliance program and promote compliant and ethical behavior in our Medicaid health plans.

Responsibilities include tracking and submitting regulatory deliverables to state Medicaid agencies, researching and recommending compliant

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 is preferred.
• Audit experience is preferred.
• Bachelor’s degree required.

Responsibilities

• Maintain systems and tools to track, monitor, review, and submit required regulatory and compliance deliverables and responses to state Medicaid agencies on or before due dates; prepare basic regulatory reports.
• Assist with research and recommendations to develop compliant business operations, processes and policies per state Medicaid requirements.
• Develop compliance communications for state Medicaid agency inquiries or requests.
• Maintain knowledge of contractual, regulatory, and program policy obligations as a Medicaid managed care organization.
• Support external audit reviews and track deliverables, responses, and corrective action plans through closure.
• Maintain internal tools, contract libraries, regulatory reporting assignments, risk registers and other oversight tools.
• Utilize systems including Microsoft products and Archer; train users and contribute to system design/maintenance.
• Support oversight and monitoring activities to evaluate compliance levels and help elevate risks and issues.
• Maintain positive relationships to influence ethical and compliant outcomes.

Skills

Regulatory compliance

Medicaid experience

Project management

Audit experience

Healthcare/insurance knowledge

MS Office

Education

Bachelor's Degree

Tools

Archer

MS Office

Job description

CVS Health is seeking a career level compliance professional to support the Medicaid managed care compliance program, reporting to the Compliance Officer and team. You will help develop and maintain systems and processes that demonstrate the principles of an effective compliance program and promote compliant and ethical behavior in our Medicaid health plans.

Responsibilities include tracking and submitting regulatory deliverables to state Medicaid agencies, researching and recommending compliant