Regulatory Compliance Analyst III - Government Programs (Medicare/Medicaid)

Overview 2 Positions Available The Analyst III is responsible for monitoring federal and state regulatory requirements that impact CareCentrix’s government programs (including Medicare Advantage and Managed Medicaid) and ensuring the compliant implementation of legal and client obligations. This role supports operational compliance by identifying risks, driving adherence to applicable regulations, and facilitating continuous improvement initiatives to maintain and strengthen compliance across the organization.

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.

Other Job Specific Competencies:

• Demonstrates ownership and accountability; operates with a degree of autonomy and consistently exercises sound judgment in decision-making.
• Able to partner with leaders to anticipate future trends, align initiatives with long-term organizational objectives, and execute into actionable plans.
• Builds strong relationships across functions, persuades stakeholders effectively, and fosters a culture of teamwork.

Qualifications

• Bachelor’s degree preferred or a minimum of 5 years’ experience in a managed care setting.
• 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

What We Offer

• Pay Range: $$80000 - $95000 / year plus corporate bonus incentive.
• Benefits: Medical, Dental, Vision, 401(k) with company match, HSA employer contributions, Dependent Care FSA employer contribution, Paid Time Off, Personal/Sick Time, Paid Parental Leave, and more.
• Award winning culture: Keeps our company values at the heart of everything we do: We Care; We Do the Right Thing; We Strive for Excellence; We Think BIG; We Take our Work Seriously, Not Ourselves.

#IDCC CareCentrix maintains a drug-free workplace. We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. CareCentrix accepts applications on an ongoing basis until a candidate is identified. Apply tot his job Apply To this Job