Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa; Columbia (SC); Remote; USD 81,000 - 138,000; Full time

Job summary

A leading career site seeks a Senior Functional Business Consultant with expertise in regulatory compliance. The role involves advising on compliance issues, improving processes, and mentoring team members. Candidates should have a strong background in business analysis and compliance, with a Bachelor's degree and extensive experience in the healthcare sector.

Qualifications

• At least 5 years in business analysis, project management, or process improvement.
• Minimum 3 years of functional experience in compliance, claims, or eligibility.
• Legal authorization to work in the U.S. without sponsorship.

Responsibilities

• Serve as a subject matter expert in business requirements and compliance.
• Advise management on laws, regulations, and policies.
• Mentor team members and ensure client satisfaction.

Skills

Client service skills

Interpersonal skills

Conflict management

Communication skills

Negotiation skills

Education

Bachelor’s degree in business, IT, or related field

HS diploma or GED

Tools

Microsoft Office

Visio

Job description

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Apply now to be among the first 25 applicants for this remote opportunity.

Lensa, the leading career site, is assisting Prime Therapeutics in finding qualified professionals. Our mission is to help people access the medicine they need to live better, which drives our passion and decision-making.

Job Posting Title

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Job Description

The Functional Business Consultant acts as a subject matter expert in business systems or processes, with a strong understanding of their designated area. Responsibilities include representing their expertise on projects, ensuring regulatory compliance, process improvement, conducting research, root cause analysis, documentation, client interaction, training, testing, support, reporting, and audit coordination.

Responsibilities

• Serve as a subject matter expert in business requirements, system specifications, process flows, and change management supporting Medicaid compliance.
• Lead or support compliance professionals, exemplifying Prime’s values.
• Advise management on laws, regulations, policies, and objectives, especially related to ACA, Government Programs, and Corporate Compliance.
• Guide internal clients on Medicaid regulatory and contractual compliance.
• Promote operational best practices and standard procedures within the assigned area.
• Research, identify root causes, and collaborate to resolve complex issues.
• Ensure prompt resolution to enhance client and member satisfaction.
• Mentor team members and perform other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in business, IT, or related field, or equivalent experience; HS diploma or GED required.
• At least 5 years in business analysis, project management, or process improvement.
• Minimum 3 years of functional experience in compliance, claims, eligibility, or related areas.
• Legal authorization to work in the U.S. without sponsorship.

Additional Qualifications

• Strong client service skills and experience in implementation.
• Ability to learn new processes/software independently.
• Excellent interpersonal, facilitation, conflict management, and communication skills.
• Proficiency in Microsoft Office and Visio.

Preferred Qualifications

• 6+ years in healthcare or regulated industries, with Medicaid and ACA experience.
• Experience with PBM or healthcare organizations.
• Knowledge of regulatory laws and certifications like CCEP, CHC, PMP.
• Strong negotiation and influencing skills.

Physical Job Requirements

• Occasional non-standard hours and travel.
• Sitting, using hands, talking, hearing; reaching; standing, walking, stooping, kneeling, crouching; lifting up to 10 pounds; vision abilities.

Reporting Structure

Reports to a Functional Business Owner, Manager, or Director in PBM Operations, Compliance, or related departments.

Compliance with security, legal, and internal policies is mandatory.

Salary range: $81,000 - $138,000 based on experience.

For benefits and incentives, visit our Benefits Page.

Prime Therapeutics is an equal opportunity employer, encouraging diverse applicants and providing accommodations as needed.