Medicaid Compliance Analyst

CVS Health•Washington, NV

3d•$43,888 - $102,081

About The Position

This career-level compliance position supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer and other team members, the analyst helps develop and maintain systems and processes that demonstrate an effective compliance program and promote compliant and ethical behavior in Medicaid health plans. The role maintains systems and tools for tracking, monitoring, reviewing, and submitting regulatory and compliance deliverables and responses to state Medicaid agencies. It also supports compliant business operations, regulatory communications, external audits, corrective action plans, compliance monitoring, and risk escalation. The analyst maintains working knowledge of contractual, regulatory, and program policy obligations and serves as a resource to health plan and growth partner staff. The position uses Microsoft products and compliance tools such as Archer, maintains related documentation, and may train system users or contribute to system design, oversight, or maintenance.

Requirements

At least 2 years of regulatory compliance experience in managed care, healthcare, or insurance, or a master's degree.
Bachelor’s degree.
Anticipated schedule of 40 hours per week.

Nice To Haves

Experience with Medicaid or Medicaid managed care.
Project management experience.
Audit experience.

Responsibilities

Track, monitor, review, and submit required regulatory and compliance deliverables and responses to state Medicaid agencies by required due dates; prepare basic regulatory reports as needed.
Assist with research and recommendations to develop compliant business operations, processes, and policies in accordance with state-specific Medicaid program requirements.
Develop compliance-related communications in response to state Medicaid agency inquiries or requests.
Maintain working knowledge of contractual, regulatory, and program policy obligations and serve as a resource to health plan and growth partner staff.
Support external audit reviews, including project management and tracking of deliverables and responses, and corrective action plan development through closure.
Maintain resource tools and internal deliverables, including contract libraries, regulatory reporting assignments, risk assessments and tracking lists, internal reporting systems, summaries, and other department-wide tools.
Use systems relevant to job functions, including Microsoft products and Archer; maintain system documentation, serve as a subject matter expert, train users, and contribute to system design, oversight, or maintenance.
Support oversight and monitoring activities evaluating compliance with Medicaid managed care organization requirements across the business.
Support business partners in developing mitigation and corrective action plans, and escalate risks, concerns, and other issues through appropriate channels.
Maintain productive relationships with internal and external constituents to communicate and influence ethical and compliant outcomes.
Perform other duties as assigned.