Medicaid Compliance Specialist — Risk & Policy

CVS Health; Santa Fe (NM); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical benefits

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health in Santa Fe, NM seeks a compliance professional to support its Medicaid managed care compliance program. You will help maintain systems for regulatory deliverables, and aid in developing compliant policies and communications for Medicaid inquiries.

This role partners with the Compliance Officer and team to ensure ethical, compliant operations and to support audits and corrective actions as needed.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance (or a Master’s degree).
• Understanding of Medicaid managed care regulatory requirements.
• Ability to develop and maintain regulatory reporting and policy documents.

Responsibilities

• Maintain systems to track, monitor, and submit regulatory deliverables to state Medicaid agencies by deadlines.
• Support development of compliant business operations, processes, and policies per Medicaid requirements.
• Create clear compliance communications in response to Medicaid agency inquiries or requests.
• Assist with external audit activities and coordinate corrective action plans through closure.

Skills

Regulatory compliance

Healthcare experience

Education

Bachelor's Degree

Tools

Microsoft Office

Archer

Job description

CVS Health in Santa Fe, NM seeks a compliance professional to support its Medicaid managed care compliance program. You will help maintain systems for regulatory deliverables, and aid in developing compliant policies and communications for Medicaid inquiries.

This role partners with the Compliance Officer and team to ensure ethical, compliant operations and to support audits and corrective actions as needed.