Government Programs Compliance Consultant

This is a fully remote position, open to applicants in Illinois, +2 more states.

📋 Description

• Assist in the evaluation of regulatory requirements for Government Programs, CMS guidance, and obligations under government contracts.

• Analyze compliance risks associated with HCSC’s Medicare Advantage business lines.

• Act as a subject matter expert on compliance related to Medicare Advantage.

• Offer guidance to ensure the accurate and timely implementation of regulatory requirements.

• Review Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements.

• Identify compliance risks tied to data integrity, payment accuracy, operational processes, and program obligations.

• Execute monitoring and oversight activities, including the review of universes and reports.

• Engage in operational meetings.

• Carry out targeted reviews in high-risk areas to evaluate the effectiveness of compliance measures.

• Work collaboratively with compliance, operational, and cross-functional teams to foster effective risk management and ensure regulatory compliance.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor’s degree with 3 years of experience in health plans, regulatory compliance, or risk management, or a total of 6 years of experience in these fields.

• Proficient in establishing communication and building relationships with internal business units.

• Skilled in forming relationships with external government agencies.

• Strong critical thinking, risk assessment, and mitigation abilities.

• Excellent verbal and written communication skills.

• Capable of working with minimal supervision.

• Demonstrated organizational, analytical, and decision-making skills.

• Proficient in PC applications, including Word, PowerPoint, and Excel.

• Experience in Government Programs Healthcare Compliance is preferred.

• Experience with Risk Adjustment is preferred.

• CHC / CRC certification is preferred.

• Familiarity with CMS regulatory frameworks is essential.

🏝️ Benefits

• Curated development plans.

• Professional development opportunities.

• 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.

• Other incentives.

• Annual incentive bonus plan.