Government Programs Compliance Consultant

🔥 12 hours ago

🌽 Illinois, Tennessee, +1 more states – Remote

🌽 Illinois – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $61.5k - $136.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Support evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations • Assess compliance risks across HCSC’s Medicare Advantage business lines • Serve as a subject matter expert on Medicare Advantage compliance • Provide guidance to ensure regulatory requirements are implemented accurately and timely • Evaluate Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements • Identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations • Conduct monitoring and oversight activities, including universe and report reviews • Participate in operational meetings • Conduct targeted reviews of high-risk areas to assess compliance effectiveness • Collaborate with compliance, operational, and cross-functional teams to promote effective risk management and regulatory compliance • Perform other duties as assigned

🎯 Requirements

• 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 • Ability to build relationships with external government agencies • 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 including Word, PowerPoint, and Excel • Government Programs Healthcare Compliance experience preferred • Risk Adjustment experience preferred • CHC / CRC preferred • Working knowledge of CMS regulatory frameworks

🏖️ Benefits

• Curated development plans • Professional development • 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