Analyst III – Regulatory Compliance, Government Programs

📋 Description

• Oversee and evaluate federal and state legislation and guidance that affects CareCentrix’s government programs (such as Medicare Advantage and Managed Medicaid) and clearly communicate updates through both written and verbal methods to relevant business sectors.

• Offer cross-departmental guidance in formulating policies, procedures, and operational modifications to guarantee compliance with legal standards, while aiding in implementation across operational teams.

• Organize and assist with compliance audits, including audits related to the Medicare Part C program, reporting, and managed Medicaid audits, ensuring prompt and accurate responses.

• Facilitate the onboarding process for new government program customers, ensuring that compliance requirements are seamlessly integrated into operational workflows.

• Propel continuous improvement initiatives aimed at enhancing compliance tracking, trending, and reporting tools for improved efficiency and accuracy.

• Perform internal audits to evaluate the effectiveness of compliance and identify areas for enhancement.

• Create and present training programs that foster a clear understanding of compliance obligations throughout the organization.

⛳️ Requirements

• Bachelor’s degree preferred or a minimum of 5 years’ experience in a managed care environment.

• At least 5 years’ experience dealing with managed care regulations that impact Medicaid health insurers and delegated entities, including, but not limited to, laws affecting utilization management, claims, network management, and credentialing.

• Proven experience in regulatory affairs and/or operations within HMOs, Managed Care Organizations, and/or government program health plans.

• Proficient in MS Office applications: Excel, SharePoint, PowerPoint, OneNote.

• Advanced skills in legal research, strong organizational and analytical capabilities, exceptional written and verbal communication/presentation skills, and keen attention to detail.

• Comprehensive knowledge of Medicare Advantage guidelines and applicable state regulations for Managed Medicaid.

🏝️ Benefits

• Medical

• Dental

• Vision

• 401(k) with company match

• HSA employer contributions

• Dependent Care FSA employer contribution

• Paid Time Off

• Personal/Sick Time

• Paid Parental Leave

• More