Compliance Program Consultant IV

Medica•St. Louis, MO

5d•$88,800 - $152,300•Hybrid

About The Position

Administers an assigned Compliance Program by providing subject matter expertise and consultation to ensure compliance with State & Federal laws, regulations and mandates. Designs and incorporates processes and internal regulations to ensure compliance standards within the organization. Performs other duties as assigned.

Requirements

Bachelor's degree or equivalent experience in related field
7+ years of work experience beyond degree
Eligibility to work in the US

Nice To Haves

Strong knowledge of Medicare, CMS, and other healthcare regulatory requirements
Ability to interpret and apply complex regulatory guidance to materials
Experience with materials review, approval and governance processes
Experience developing workflows, SOPs or process improvements

Responsibilities

Lead compliance review of materials across all lines of business, including member, provider, broker and public-facing communications.
Ensure materials adhere to applicable regulatory requirements, internal policies and established compliance standards.
Interpret complex and evolving regulatory requirements and apply them consistently across materials.
Serve as escalation point for complex, high-risk or ambiguous materials determinations.
Design and maintain materials review workflows and governance processes, including intake, review, approval and documentation standards.
Develop and document standard operating procedures (SOPs) to support consistent and compliant materials review practices.
Create and maintain job aids and training materials to support efficient and consistent execution of materials review processes by team members and business partners.
Monitor materials review activities and outcomes to ensure ongoing compliance with regulatory requirements, internal standards and established review processes.
Maintain and update materials tracking tools, logs and repositories to ensure complete and accurate documentation of review decisions and approvals.
Provide program support through participation in special projects, process improvement initiatives and cross-functional compliance efforts.