Government Programs Compliance Consultant

HCSC•Albuquerque, NM

4d•Hybrid

About The Position

This position is responsible for supporting the evaluation of government programs (Medicare and Medicaid) regulations, guidance, and contracts, assessing the risk that those items present with respect to HCSC government contracts. It supports the compliance department's oversight of business operational compliance with requirements through multiple mechanisms such as review of reports, attendance at operational meetings, and targeted monitoring of areas of concern. This role assists in the identification of risks and issues of noncompliance, development of strategies to mitigate and remediate those risks and issues, and works with compliance and business personnel, all levels of HCSC management, and governmental agencies to implement controls and processes and report on results.

Requirements

Bachelor’s degree and 3 years experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance or risk management.
Ability to communicate with and build relationships with internal business units and/or various external government agencies.
Critical thinking, risk assessment and mitigation.
Excellent verbal and written communication skills.
Ability to work with minimal supervision.
Organizational, analytical and decision-making skills.
PC proficiency to include Workday, Word, PowerPoint and Excel.

Nice To Haves

Government Programs Healthcare Compliance experience.
Equivalent experience will be considered.
Knowledge of Medicaid contracts and regulations, Medicare Advantage, Part D or other regulatory experience.
Bachelor’s Degree or higher preferred.
Government programs operational experience.

Responsibilities

Identify, review, analyze and understand contractual and regulatory requirements.
Evaluate Government regulations, guidance and contracts, and identify specific risks that they present to HCSC government contracts.
Review Government Programs policies and procedures, workflows, training materials and other documentation for compliance with requirements.
Consult with the business and provide guidance as the business plans, implements and monitors its compliance with contractual and regulatory requirements.
Identify and follow up on compliance issues and track issues to resolution.
Provide accurate and complete documentation of reported information, risks, issues, status and results.
Work with the business to agree upon issues, root causes, remediation steps, deliverables, additional training and education, communications, internal controls, compliance reviews or modifications to processes and due dates.
Participate in issue resolution process which may include, as appropriate, but is not limited to: identifying barriers to meeting due dates, identifying actions or escalations needed to address barriers, escalating failure to meet due dates, escalating barriers appropriately, recommending disciplinary actions or other appropriate means to hold business owners accountable for actions or lack of actions.
Validate that business remediation activities successfully addressed agreed-upon root causes, deliverables and remediation steps.
Participate in remediation activities including: identification of root cause(s), identification and stratification of risks, development and implementation of recommendations for processes that would result in their mitigation.
Assist in development of remediation plans with the business including setting agreed-upon actions, deliverables and due dates and track execution of the remediation plan.
Consult with business owners, which may include participating in regular meetings, working with management to identify and mitigate risks and coordinating responses to questions from regulators.
Communicate with internal and external stakeholders at all levels throughout HCSC to achieve effective outcomes.
Perform targeted monitoring and/or reviews to determine if HCSC is in compliance with the terms of specific government contracts, regulations, guidance and private contracts. Document results and communicate findings to the business.
Provide input related to the Risk Assessment process in order to most effectively stratify the risks presented by government business.
Coordinate, facilitate and take notes at internal and external meetings, including meetings with regulators. Prepare and distribute materials to participants.
Review operational reports from the business, track and trend results and identify issues or risks of noncompliance.
Create summary reports for management on issues and risks of non-compliance.
Report on Compliance Program activities, effectiveness and status, including ad hoc and routine management reports.
Contribute to preparation of quarterly compliance reports to HCSC boards and committees.