Government Programs Compliance Consultant

• This position is responsible for supporting evaluation of government programs (Medicare and Medicaid) regulations, guidance and contracts, assessing the risk that those items present with respect to HCSC government contracts.
• Supporting the compliance department oversight of the business' operational compliance with the requirements through multiple mechanisms such as review of reports, attendance at operational meetings, and targeted monitoring of areas of concern.
• Assisting in identification of risks and issues of noncompliance, development of strategies to mitigate and remediation of those risks and issues and work with compliance and business personnel, all levels of HCSC management and governmental agencies in order to implement controls and processes and report on results.
• Validate that business remediation activities successfully addressed agreed-upon root causes, deliverables and remediation steps.
• Document results and communicate findings to the business.
• Create summary reports for management on issues and risks of non-compliance.

• Bachelor’s degree and 3 years experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance or risk management.
• Ability to communicate with and build relationships with internal business units and/or various external government agencies.
• Critical thinking, risk assessment and mitigation.
• Excellent verbal and written communication skills.
• Ability to work with minimal supervision.
• Organizational, analytical and decision-making skills.
• PC proficiency to include Workday, Word, PowerPoint and Excel.
• Preferred Requirements:
  Government Programs Healthcare Compliance experience. Equivalent experience will be considered. Knowledge of Medicaid contracts and regulations, Medicare Advantage, Part D or other regulatory experience.

Demonstrates expertise in regulatory compliance and risk management within healthcare programs, particularly Medicare and Medicaid, while effectively communicating findings and collaborating with various stakeholders to ensure operational compliance.

• Regulatory Compliance
• Risk Management
• Medicare And Medicaid Knowledge
• Critical Thinking
• Communication Skills

• Risk Assessment
• Mitigation Strategies
• Operational Compliance
• Report Documentation
• Data Analysis

• Organizational Skills
• Analytical Skills
• Decision-Making Skills
• Relationship Building

• Government Programs
• Healthcare Compliance
• Medicaid Contracts
• Medicare Advantage
• Part D Regulations

• Workday
• Microsoft Word
• Microsoft Power Point
• Microsoft Excel