Sr. Compliance Review Analyst

State of North Carolina

22h • Hybrid

About The Position

The Compliance Office at NC Medicaid has primary responsibility for ensuring NC Medicaid has an effective overall risk management and compliance program and conducts activities to detect and prevent fraud, waste, and abuse of Medicaid dollars. Additionally, the Compliance Office works within the Division to assist in the identification and mitigation of business and operational risks to the program. The Senior Compliance Review Analyst (CRA) is a seasoned professional responsible for conducting internal control reviews across the Medicaid agency. This role ensures operational integrity by assessing compliance with state and federal regulations, identifying control gaps, and collaborating with leadership to design and implement mitigating strategies. The CRA will serve as a trusted advisor to program leaders, providing actionable insights that strengthen compliance and reduce risk. The CRA also monitors progress of remediation and corrective action plans to ensure risks are mitigated in a timely manner. This role plays a crucial part in fostering a culture of compliance within NC Medicaid.

Requirements

• Bachelor’s degree from appropriately accredited institution in a discipline related to the area of assignment with three years of programmatic experience related to the area of assignment; or an equivalent combination of training and experience.

Nice To Haves

• Thorough knowledge of audit methodologies and compliance review techniques.
• Considerable knowledge of internal control frameworks (e.g., COSO) and risk management principles.
• Considerable knowledge of current federal, state and local government programs.
• Working knowledge of healthcare operations, provider billing, and claims processes.
• Strong analytical skills for evaluating processes and identifying control gaps.

Responsibilities

• Assist in designing compliance review procedures based upon review objectives
• Conduct compliance review activities ensuring adequate documentation of adherence to policies, procedures, regulatory requirements and best practices.
• Consult with business functions to develop efficient and effective processes and procedures implementing mitigating controls and process improvements.
• Draft compliance status memorandums to NC Medicaid leadership, presenting findings in clear, actionable terms.
• Prepare detailed review reports, including findings, risk assessments, and recommendations.
• Track outstanding compliance issues
• Facilitate discussions to prioritize remediation efforts and monitor progress.
• Maintain accurate records of reviews and follow-up actions
• Stay current on Medicaid regulations, CMS guidance, and internal audit best practices.
• Contribute to the development of compliance frameworks and training materials.

Benefits

• The State of North Carolina offers excellent comprehensive benefits.
• Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis).
• Employees also receive paid vacation, sick, and community service leave.
• In addition, paid parental leave is available to eligible employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level