Behavioral Health Compliance Senior Consultant (Compliance Consultant Senior)

Elevance Health•Indianapolis, IN

5d•Hybrid

About The Position

The Behavioral Health Compliance Senior Consultant (Compliance Consultant Senior) supports compliance activities across behavioral health operations through regulatory research, audit coordination, issue management, compliance monitoring, and compliance consultation. The role partners with business stakeholders to identify compliance requirements, facilitate remediation activities, support audit readiness efforts, and promote adherence to applicable federal and state regulations, contractual obligations, accreditation standards, and organizational policies.

Requirements

Requires a BA/BS and minimum of 5 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.
Travels to worksite and other locations as necessary.

Nice To Haves

Minimum of 4 years of experience in healthcare compliance, regulatory affairs, audit, risk management, or a related field highly preferred.
Experience supporting behavioral health, managed care, Medicare, Medicaid, or health plan operations highly preferred.
Experience conducting regulatory research, compliance analysis, and interpreting federal and state healthcare regulations highly preferred.
Experience supporting audits, examinations, investigations, issue management, or remediation activities highly preferred.
Knowledge of NCQA, CMS, Medicaid, Medicare, and behavioral health regulatory requirements highly preferred.
Strong written, verbal, analytical, and organizational skills preferred.
Ability to manage multiple priorities and deadlines in a fast-paced environment preferred.
Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Teams preferred.
Experience with ServiceNow or other compliance, audit, or issue management systems preferred.
Certified in Healthcare Compliance (CHC) or other relevant compliance certification highly preferred.

Responsibilities

Provide senior level analytical support to projects, initiatives, regulatory audits or exams, internal audits, risk assessments.
Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.
Support behavioral health compliance by researching and interpreting federal and state regulations, contractual requirements, and accreditation standards, while providing compliance guidance and recommendations to business stakeholders.
Coordinate compliance audits and reviews by managing regulatory examinations, delegated entity audits, document collection, evidence tracking, audit readiness, and remediation efforts.
Manage compliance issues and risk mitigation by investigating compliance concerns, tracking corrective action plans, performing root cause analysis, monitoring issue resolution, and escalating significant risks as appropriate.
Collaborate across the organization to support compliance initiatives, build stakeholder relationships, facilitate cross-functional projects, improve compliance processes, and contribute to organizational readiness and operational effectiveness.