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CareCentrix · 14 hours ago

Analyst III - Regulatory Compliance - Government Programs

United States

Full-time

Remote

Senior Level

$80K/yr - $89K/yr

5+ years exp

CareCentrix is focused on compliance within government programs, and they are seeking an Analyst III to monitor federal and state regulatory requirements. This role involves ensuring compliance with legal obligations, supporting operational compliance, and facilitating continuous improvement initiatives.

Health CareHome Health CareWellness

Responsibilities

Monitor and analyze federal and state laws and guidance impacting CareCentrix’s government programs (e.g., Medicare Advantage and Managed Medicaid) and communicate updates clearly through written and verbal channels to relevant business areas

Provide cross-functional guidance in developing policies, procedures, and operational changes to ensure compliance with legal requirements, and support implementation across operational teams

Coordinate and support compliance audits, including Medicare Part C program audits, reporting, and managed Medicaid audits, ensuring timely and accurate responses

Assist with onboarding new government program customers, ensuring compliance requirements are integrated into operational processes

Drive continuous improvement initiatives to enhance compliance tracking, trending, and reporting tools for greater efficiency and accuracy

Conduct internal audits to assess compliance effectiveness and identify opportunities for improvement

Design and deliver training programs that promote a clear understanding of compliance requirements across the organization

Qualification

Regulatory complianceManaged care lawsMedicare Advantage guidelinesLegal researchMS Office proficiencyAnalytical skillsCommunication skillsAttention to detailCollaborationStrategic thinking

Required

Minimum 5 years' experience working with managed care laws impacting Medicare Advantage and/or managed Medicaid health insurers and delegated entities, including but not limited to, laws impacting utilization management, claims, network management, and credentialing

Demonstrated experience in regulatory affairs and/or operations of HMOs, Managed Care Organization's and/or government program health plans

Proficiency in MS Office: Excel, SharePoint, PowerPoint, OneNote

Advanced legal research skills, advanced organizational and analytical skills, excellent written and verbal communication/presentation skills and attention to detail

Strong knowledge of Medicare Advantage guidelines and state regulations applicable to Managed Medicaid