Government Programs Compliance Consultant
About The Position
This position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines. Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely. Responsibilities include evaluating Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations. Conducts monitoring and oversight activities, including universe and report reviews, operational meeting participation, and targeted reviews of high-risk areas to assess compliance effectiveness. Additional responsibilities include collaborating with compliance, operational, and other cross functional teams to promote effective risk management and regulatory compliance, and perform other duties as assigned.
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.
- Build relationships with various external government agencies.
- Critical thinking, risk assessment, and mitigation.
- Verbal and written communication skills.
- Ability to work with minimal supervision.
- Organizational, analytical, and decision-making skills.
- PC proficiency to include Word, PowerPoint, and Excel.
Nice To Haves
- Government Programs Healthcare Compliance experience
- Risk Adjustment experience.
- CHC / CRC preferred.
- Working knowledge of CMS regulatory frameworks
Responsibilities
- Evaluate Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations.
- Conduct monitoring and oversight activities, including universe and report reviews, operational meeting participation, and targeted reviews of high-risk areas to assess compliance effectiveness.
- Collaborate with compliance, operational, and other cross functional teams to promote effective risk management and regulatory compliance.
- Perform other duties as assigned.
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
