Medicaid Compliance Consultant

Job Summary

To enhance the Medicaid Compliance Program, the full-time remote Medicaid Compliance Consultant will advise regional staff on Medicaid requirements, develop compliant procedures, monitor performance metrics, conduct risk assessments, and provide training on compliance issues.

Key responsibilities:

• Develop compliance reports by evaluating data and summarizing audit information to report key compliance drivers to management
• Conduct compliance investigations by collecting and analyzing data, conducting interviews, and providing input for corrective action plans
• Coordinate the implementation of compliance efforts by assessing current compliance states, identifying gaps, and creating or revising compliance standards and training

Required qualifications:

• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field
• Minimum six years of experience in compliance, health care operations, audit, finance, or related fields
• Experience in health plan compliance and operations preferred
• Project management experience is a plus
• Certified in Healthcare Compliance (CHC) or equivalent compliance certification is preferred