Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa; Little Rock (AR); 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. This remote role involves serving as a subject matter expert, advising on compliance issues, and leading operational best practices. Ideal candidates will have a strong background in business analysis and client service skills, with at least 5 years of relevant experience. A bachelor's degree is required, along with proficiency in various software tools. Join a diverse and inclusive team committed to improving healthcare services.

Qualifications

• 5 years of experience in business analysis, project management, or process improvement.
• 3 years of functional experience in compliance, claims, eligibility, or related areas.

Responsibilities

• Represent business system as a subject matter expert in compliance.
• Advise internal clients on Medicaid regulatory requirements.
• Independently research and resolve complex business issues.

Skills

Client Service Skills

Interpersonal Skills

Communication Skills

Presentation Skills

Self-learning Capability

Education

Bachelor’s degree in business administration

HS diploma or GED

Tools

MS Word

Excel

Project

PowerPoint

Visio

Job description

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa is the leading career site for job seekers at every stage of their career. Our client, Prime Therapeutics, is seeking professionals. Apply via Lensa today!

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

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

• Represents assigned business system or business process as a subject matter expert in business requirements, system specifications, process flows, process change and/or project management in supporting Compliance with Medicaid requirements.
• Provide direct, or indirect leadership to other compliance professionals, consistently role modeling Prime’s employee and leadership expectations.
• Serves as a consultant to management on major laws and regulations, policies, plans, and objectives, providing Subject Matter Expertise in areas such as Affordable Care Act, Government Programs, and Corporate Compliance.
• Advise internal clients regarding compliance with State and Federal Medicaid regulatory and contractual requirements.
• Provides leadership in identifying and adopting operational best practices and standard operating procedures related to the assigned business system or process.
• Independently researches, determines root causes, and collaborates to resolve complex business and technical issues and customer inquiries.
• Provides prompt and thorough resolution for client and/or member satisfaction.
• May guide, mentor, and direct other team members.
• Other duties as assigned.

Minimum Qualifications

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

Additional Qualifications

• Proven client service skills and ability to build strong relationships.
• Implementation experience.
• Self-learning capability for new processes/software.
• Excellent interpersonal, communication, and presentation skills.
• Ability to handle multiple projects under pressure.
• Proficiency in MS Word, Excel, Project, PowerPoint, and Visio.

Preferred Qualifications

• 6+ years in legal or compliance roles within healthcare or highly regulated industries, including Medicaid and ACA experience.
• Experience with PBM or healthcare operations.
• Knowledge of federal and state regulatory laws and guidance.
• Certifications such as CCEP, CHC, PMP preferred.

Physical Job Requirements

• Occasional non-standard hours and travel.
• Physical activities include sitting, handling, talking, hearing, reaching, standing, walking, stooping, kneeling, crouching, and lifting up to 10 pounds.
• Specific vision abilities required.

Reporting Structure

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

Employees must adhere to security responsibilities and legal requirements. Pay ranges from $81,000 to $138,000, based on experience. For benefits details, visit our Benefits Page. Prime Therapeutics is an equal opportunity employer committed to diversity and inclusion. We welcome applicants of all backgrounds and provide accommodations as needed.