Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Lensa; Washington (District of Columbia); 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 providing subject matter expertise, advising on compliance matters, and leading operational best practices. Candidates should have a strong background in business analysis and project management, with a focus on Medicaid and government programs. The position requires excellent communication skills and the ability to manage multiple projects effectively.

Qualifications

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

Responsibilities

• Represent assigned business system as a subject matter expert.
• Advise internal clients on compliance with Medicaid regulatory requirements.
• Mentor and guide team members as needed.

Skills

Client Service Skills

Interpersonal Skills

Communication Skills

Presentation Skills

Education

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

Tools

Microsoft Office

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 regarding 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 in business requirements, system specifications, process flows, process change, and project management 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 the Affordable Care Act, Government Programs, and Corporate Compliance.
• Advise internal clients on compliance with State and Federal Medicaid regulatory and contractual requirements.
• Lead the adoption of operational best practices and standard operating procedures related to the assigned business system or process.
• Research, determine root causes, and collaborate to resolve complex business and technical issues and customer inquiries.
• Provide 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.
• Minimum 3 years of functional experience in areas such as compliance, claims, eligibility, or related.
• Eligibility to work in the US without sponsorship.

Additional Qualifications

• Strong client service skills and ability to build relationships.
• Experience with implementation projects.
• Self-learner of processes and software to solve analytical problems.
• Excellent interpersonal, communication, and presentation skills.
• Ability to manage multiple projects under tight deadlines.
• Proficiency in Microsoft Office applications.

Preferred Qualifications

• Over 6 years of experience in legal or compliance roles within healthcare or regulated industries.
• Experience with Medicaid, ACA, and government programs.
• Legal or regulatory experience with state and federal laws and regulations.
• Certifications such as CCEP, CHC, PMP are preferred.

Physical Job Requirements

• Occasional non-standard hours and travel.
• Ability to sit, handle, talk, hear, reach, stand, walk, and lift up to 10 pounds.
• Visual requirements include close, distance, color, peripheral, and depth perception.

Reporting Structure

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

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

For benefits details, visit our Benefits Page.

Prime Therapeutics is an equal opportunity employer and values diversity. We welcome applicants from all backgrounds and those requiring accommodations.