Compliance Consultant Senior

Elevance Health•Cincinnati, OH

5d•Hybrid

About The Position

The Compliance Consultant Senior is responsible for delivering and executing foundational and strategic compliance responsibilities with consistent excellence that support the team and management at the most senior advanced level. This role is part of the Ohio Medicaid Market Team. Function as point of contact for member and provider complaints received by the Ohio Medicaid Regulator. Process regulator Ad Hoc inquiries, and coordinates and tracks collateral submissions as required by the state contract. Additional internal responsibilities include policy reviews, regulatory grid completion and job aid development and updates. At the most senior advanced level, report, communicate, research laws, regulations, requirements, regulatory audits and/or exams. Provide senior level analytical support to projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments. Utilize systems unique to job functions, including standard-issue software such as Microsoft products; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance. Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.

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

Proficient utilizing MS-Office

Responsibilities

Function as point of contact for member and provider complaints received by the Ohio Medicaid Regulator.
Process regulator Ad Hoc inquiries, and coordinates and tracks collateral submissions as required by the state contract.
Policy reviews, regulatory grid completion and job aid development and updates.
Report, communicate, research laws, regulations, requirements, regulatory audits and/or exams.
Provide senior level analytical support to projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments.
Utilize systems unique to job functions, including standard-issue software such as Microsoft products; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance.
Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.