Note: The job is a remote job and is open to candidates in USA. Health Care Service Corporation is a purpose-driven health insurance organization seeking a Government Programs Compliance Consultant to evaluate Medicare Advantage regulatory requirements, CMS guidance, and government contract obligations. The role assesses compliance risks, conducts monitoring and oversight activities, and collaborates with cross-functional teams to support risk management and regulatory compliance.
Responsibilities
- This position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines
- Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely
- Responsibilities include evaluating Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations
- Conducts monitoring and oversight activities, including universe and report reviews, operational meeting participation, and targeted reviews of high-risk areas to assess compliance effectiveness
- Additional responsibilities include collaborating with compliance, operational, and other cross functional teams to promote effective risk management and regulatory compliance, and perform other duties as assigned
Skills
- 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
- Build relationships with various external government agencies as well
- Critical thinking, risk assessment, and mitigation
- Verbal and written communication skills
- Ability to work with minimal supervision
- Organizational, analytical, and decision-making skills
- PC proficiency to include Word, PowerPoint, and Excel
- Government Programs Healthcare Compliance experience
- Risk Adjustment experience
- CHC / CRC preferred
- Working knowledge of CMS regulatory frameworks
Benefits
- 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 subject to the terms and the conditions of the plan
- Curated development plans that foster growth and promote rewarding, fulfilling careers
- Remote work
Company Overview
Company H1B Sponsorship