Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa; Denver (CO); Remote; USD 81,000 - 138,000; Full time

Job summary

A leading company is seeking a Senior Functional Business Consultant with expertise in regulatory compliance to support Medicaid requirements. The role involves advising management, mentoring team members, and ensuring client satisfaction. Ideal candidates will have strong client service skills and a background in compliance within healthcare or regulated industries.

Qualifications

• At least 5 years in business analysis, project management, or process improvement.
• 3 years in compliance, claims, eligibility, or related areas.

Responsibilities

• Represent assigned business system as a subject matter expert.
• Advise management on laws, regulations, policies, and plans.
• Research and resolve complex business and technical issues.

Skills

Client Service Skills

Interpersonal Skills

Communication Skills

Education

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

Tools

MS Office

Job description

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

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Job Posting Title

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Job Description

The Functional Business Consultant serves as a business system or business process subject matter expert with a high level of understanding of their assigned area. This position will represent their area of expertise with regard to business system knowledge on internal and client projects, regulatory requirements, process improvement, advanced research, root cause analysis, complex issue research, documentation, advanced communications, client interaction, training, testing, ongoing system support, and developing reports and coordinating audits.

Responsibilities

• Represent assigned business system or process as a subject matter expert supporting compliance with Medicaid requirements.
• Provide leadership to compliance professionals, role modeling Prime’s expectations.
• Advise management on laws, regulations, policies, and plans, offering subject matter expertise in areas like ACA, Government Programs, and Corporate Compliance.
• Guide internal clients on compliance with State and Federal Medicaid regulations.
• Lead in adopting operational best practices and standard procedures related to assigned systems or processes.
• Research and resolve complex business and technical issues, collaborating with others.
• Ensure prompt resolution for client and member satisfaction.
• Mentor and guide team members as needed.
• 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, including 3 years in compliance, claims, eligibility, or related areas.
• Legal authorization to work in the US without sponsorship.

Additional Qualifications

• Strong client service skills and experience building client relationships.
• Implementation experience.
• Self-motivated learner for new processes/software.
• Excellent interpersonal, facilitation, and communication skills.
• Ability to manage multiple projects under pressure.
• Proficiency in MS Office tools.

Preferred Qualifications

• 6+ years in legal or compliance roles within healthcare or regulated industries.
• Experience with Medicaid, ACA, and government programs.
• Regulatory experience with state and federal laws.
• Certifications like CCEP, CHC, PMP are a plus.

Physical Requirements

• Occasional non-standard hours and travel.
• Sitting, handling, talking, hearing, reaching, standing, walking, and lifting up to 10 pounds as needed.
• Vision requirements include various visual acuities.

Reporting Structure

• Reports to a Functional Business Owner, Manager, or Director in relevant departments.

All employees must adhere to security and compliance policies. Salary ranges from $81,000 to $138,000 depending on experience. For benefits details, visit our Benefits Page.

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