Analyst,Corp Compliance

CVS Health•Work At Home-Pennsylvania, MI

2d•$43,888 - $93,574

About The Position

This career-level compliance position supports the compliance program activities and deliverables of a Medicaid managed care organization. Working in partnership with and under the direction of the health plan Compliance Officer and other team members, the analyst helps develop and maintain systems and processes that demonstrate an effective Compliance program and promote compliant and ethical behavior in Medicaid health plans. The analyst tracks, monitors, reviews, and submits regulatory and compliance deliverables and responses to state Medicaid agencies by required deadlines, and prepares basic regulatory reports. The role researches and recommends compliant business operations, processes, and policies; prepares communications in response to agency inquiries; and maintains working knowledge of the health plan’s contractual, regulatory, and program-policy obligations. The analyst supports external audits, including tracking deliverables and responses and developing corrective action plans through closure, and maintains compliance resources, tools, and reporting systems. The position also uses and maintains job-specific systems, including Microsoft products and Archer, and supports compliance oversight, monitoring, risk escalation, and effective relationships with internal and external constituents. Other duties may be assigned.

Requirements

Bachelor’s degree required; a Risk Management degree is strongly preferred. Related degrees such as Healthcare Administration, Public Health, Business Administration, Finance, Accounting, and Legal Studies may also be considered.
0–2 years of experience in regulatory compliance, managed care, healthcare, insurance, audit, risk management, or a related field preferred.

Nice To Haves

Experience with Medicaid or Medicaid managed care.
Project management experience.
Audit experience.
Risk Management degree.

Responsibilities

Track, monitor, review, and submit required regulatory and compliance deliverables and responses to state Medicaid agencies by required deadlines; prepare basic regulatory reports as needed.
Research and recommend compliant business operations, processes, and policies in accordance with state-specific Medicaid program requirements.
Develop compliance-related communications in response to state Medicaid agency inquiries or requests.
Maintain working knowledge of the health plan’s contractual, regulatory, and program-policy obligations and serve as a resource to health plan and growth partner staff.
Support external audit reviews, including project management and tracking of deliverables and responses and development of corrective action plans through closure.
Maintain current compliance resources and internal deliverables, including the contract library, regulatory reporting assignments, risk assessments, risk tracking lists, reporting systems, and summaries.
Use and maintain job-specific systems, including Microsoft products and Archer; maintain system documentation, serve as a subject matter expert, train system users, and contribute to system design, oversight, or maintenance.
Support oversight and monitoring of compliance with Medicaid managed care organization requirements across the business.
Support business partners in developing mitigation and corrective action plans and escalate risks, concerns, and other issues through appropriate channels.
Maintain productive relationships with internal and external constituents to communicate and influence ethical and compliant outcomes.
Perform other duties as assigned.