Medicaid Compliance Analyst

CVS Health•Baton Rouge, LA

2d•$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 analyst maintains tools and systems for tracking, monitoring, reviewing, and submitting regulatory and compliance deliverables and responses to state Medicaid agencies, and prepares basic regulatory reports. The role researches and recommends compliant business operations, processes, and policies consistent with state-specific Medicaid requirements; develops communications in response to agency inquiries; and serves as a resource on the health plan’s contractual, regulatory, and program policy obligations. The position supports external audits, including project management and tracking of deliverables, responses, and corrective action plans through closure. It also maintains compliance resources and internal tools, uses and supports job-specific systems such as Microsoft products and Archer, and contributes to system documentation, training, design, oversight, and maintenance. In partnership with senior team members, the analyst supports compliance oversight and monitoring across the business, helps business partners develop mitigation and corrective action plans, escalates risks and issues, and maintains productive relationships with internal and external constituents.

Requirements

At least 2 years of regulatory compliance experience in managed care, healthcare, or insurance, or a master’s degree.
Bachelor’s degree.
Ability to maintain working knowledge of contractual, regulatory, and Medicaid program policy obligations.
Ability to communicate and work productively with internal and external constituents.

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.
Research and recommend 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 the health plan’s 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 current compliance resources and internal tools, including the contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems, and summaries.
Use job-specific systems, maintain system documentation, serve as a subject matter expert, train system users, and contribute to system design, oversight, or maintenance.
Support oversight and monitoring activities to evaluate 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 positive, productive relationships with internal and external constituents to communicate effectively and influence ethical and compliant outcomes.
Perform other duties as assigned.