Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa; Richmond (VA); Remote; USD 81,000 - 138,000; Full time

Job summary

A leading healthcare organization is seeking a Senior Functional Business Consultant with expertise in regulatory compliance. This remote position requires a strong background in business analysis and project management, focusing on Medicaid compliance. The ideal candidate will demonstrate excellent client service and communication skills while leading compliance efforts and providing subject matter expertise. Join a dynamic team committed to improving healthcare outcomes and making a difference in people's lives.

Qualifications

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

Responsibilities

• Serve as a subject matter expert in business requirements and compliance.
• Advise internal clients on Medicaid regulatory requirements.
• Provide leadership in identifying operational best practices.

Skills

Client Service Skills

Interpersonal Skills

Analytic Problem Solving

Communication

Education

Bachelor’s degree in business administration

HS diploma or GED

Tools

Microsoft Word

Microsoft Excel

Microsoft Project

Microsoft PowerPoint

Microsoft Visio

Job description

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

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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 matters pertaining to laws and regulations, policies, plans and objectives and provides Subject Matter Expertise in their areas of focus (Affordable Care Act, Government Programs, Corporate Compliance)
• Advise internal clients regarding compliance with State and Federal Medicaid regulatory and contractual requirements
• Provides leadership to the business in the identification and adoption of operational best practices and standard operating procedures as it relates to assigned business system or business process
• Independently researches, determines root cause and collaborates with others to resolve complex business and technical issues and customer inquiries.
• Provides prompt and thorough resolution for client and/or member satisfaction
• May provide guidance, mentoring, and work direction to others on the team
• Other duties as assigned

Minimum Qualifications

• Bachelor’s degree in business administration, IT or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 5 years of work experience in business analysis, project management, and/or process improvement to include:
• 3 years of functional experience in at least one of the specific areas for position (e.g., compliance, claims, eligibility, product, benefits, implementations or related area)
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Proven client service skills with a track record for building strong client relations
• Implementation experience
• Self learns new processes/software to solve analytic problems
• Expert interpersonal skills necessary to drive results and deliver on commitments in a collaborative fashion
• Skillful at meeting facilitation, conflict management, and consensus building
• Capable of handling multiple projects simultaneously and ability to work under pressure with strict timelines in a fast-paced work environment
• Excellent verbal and written communication skills with prior experience giving presentations
• Proficiency in Microsoft Word, Excel, Project, PowerPoint, and Visio

Preferred Qualifications

• 6 years of progressive work experience in legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated industry, including experience with Medicaid, the Affordable Care Act (ACA) and government programs
• Previous PBM or healthcare experience
• Legal and/or regulatory experience working with new/proposed and final State and Federal regulatory laws, guidance, and regulations
• Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC)
• Certified Project Management Professional (PMP)
• Expert communication, negotiation and influencing skills

Minimum Physical Job Requirements

• Occasional non-standard hours and travel may be required
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to a Functional Business Owner, Manager or Director in PBM Operations, Specialty Operations, Clinical Operations, Compliance, Finance or Supply Chain Shared Services

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [e-mail].