Senior Consultant Compliance Program Effectiveness (Full-time)
Job Summary:
Responsible for providing subject matter expertise on Compliance in order to effectively support our clients.
Essential Functions:
- Subject matter expertise in an operational function of Compliance
- Ability to review, interpret and implement state and federal guidance, including Medicare Advantage, Medicaid, Federally Facilitated Exchange, and commercial insurance programs.
- Support CMS mock program audits to evaluate Compliance Program Effectiveness across audited program areas.
- Provides guidance to clients on compliance program activities such as risk assessment, compliance plan development, monitoring, auditing, delegation oversight, root cause analysis, and corrective action plans.
- Oversee and administer ongoing audit and monitoring program(s) based on guidance, through project work and/or interim compliance assignments.
- Provide feedback, draft and/or updates policies, procedures, and compliance documentation.
- Support and mentor peers where applicable and drive work product based on project assignment.
- Adhere to established corporate policies and procedures
- Perform other duties, as necessary, to meet corporate objectives
- Travel as required
Qualifications:
- Bachelor’s degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance, or quality profession (equivalent combination of education and experience considered.)
- Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access, and PowerPoint required
- Experience with Medicare, Medicaid, Commercial insurance, Federally Facilitated Exchange, and/or Healthcare Provider compliance standards required.
- Advanced degree or certification in audit, pharmacy or compliance discipline preferred
- Must have strong verbal and written communication skills.
- Individual should be detail oriented with strong organization, prioritization, and analytical skills with the ability to work independently.
- Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.
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Senior Consultant, Compliance Program Effectiveness (Full-time)
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