Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa; Tallahassee (FL); 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, leading compliance initiatives, and advising on Medicaid requirements. Candidates should have a strong background in business analysis and client relations, with at least 5 years of relevant experience.

Qualifications

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

Responsibilities

• Represent assigned business system as a subject matter expert.
• Provide leadership to compliance professionals.
• Advise on compliance with Medicaid regulatory requirements.

Skills

Client service skills

Interpersonal skills

Communication skills

Presentation skills

Proficiency in Microsoft Office tools

Education

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

HS diploma or GED

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 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 leadership to other compliance professionals, role modeling Prime’s employee and leadership expectations.
• Serve as a consultant to management on laws, regulations, policies, plans, and objectives, providing Subject Matter Expertise in areas such as Affordable Care Act, Government Programs, and Corporate Compliance.
• Advise internal clients on compliance with State and Federal Medicaid regulatory and contractual requirements.
• Lead or support the adoption of operational best practices and standard operating procedures related to assigned systems or processes.
• Research, determine root causes, and collaborate to resolve complex business and technical issues and inquiries.
• Ensure prompt and thorough 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 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, benefits, or related areas.
• Legal authorization to work in the U.S. without sponsorship.

Additional Qualifications

• Strong client service skills and experience building client relations.
• Implementation experience.
• Proactive learner of new processes and software.
• Excellent interpersonal, communication, and presentation skills.
• Ability to handle multiple projects under pressure.
• Proficiency in Microsoft Office tools.

Preferred Qualifications

• Over 6 years in legal or compliance roles within healthcare or regulated industries, with Medicaid and ACA experience.
• Previous experience in PBM or healthcare.
• Knowledge of regulatory laws and guidance.
• Certifications such as CCEP, CHC, PMP preferred.

Physical Job Requirements

• Occasional non-standard hours and travel.
• Physical ability to sit, handle, hear, reach, stand, walk, and lift up to 10 pounds.
• Visual acuity for various vision needs.

Reporting Structure

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

All employees must comply with security responsibilities, legal, regulatory, and internal policies.

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

For benefits details, visit our Benefits Page.

Prime Therapeutics is an equal opportunity employer, encouraging diverse candidates to apply, and provides accommodations for applicants with disabilities.