Senior Functional Business Consultant/ Regulatory Compliance exp

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Senior Functional Business Consultant/ Regulatory Compliance exp required- REMOTE

Job Description

The Functional Business Consultant serves as a business system or business process subject matter expert with a high level of understanding of their assigned area. This position will represent their area of expertise with regard to business system knowledge on internal and client projects, regulatory requirements, process improvement, advanced research, root cause analysis, complex issue research, documentation, advanced communications, client interaction, training, testing, ongoing system support, and developing reports and coordinating audits.

Responsibilities

Represents assigned business system or business process as a subject matter expert in business requirements, system specifications, process flows, process change and/or project management in supporting Compliance with Medicaid requirements.

Provide direct, or indirect leadership to other compliance professionals, consistently role modeling Prime’s employee and leadership expectations

Serves as a consultant to management on major matters pertaining to laws and regulations, policies, plans and objectives and provides Subject Matter Expertise in their areas of focus (Affordable Care Act, Government Programs, Corporate Compliance)

Advise internal clients regarding compliance with State and Federal Medicaid regulatory and contractual requirements

Provides leadership to the business in the identification and adoption of operational best practices and standard operating procedures as it relates to assigned business system or business process

Independently researches, determines root cause and collaborates with others to resolve complex business and technical issues and customer inquiries.

Provides prompt and thorough resolution for client and/or member satisfaction

May provide guidance, mentoring, and work direction to others on the team

Other duties as assigned

Minimum Qualifications

Bachelor’s degree in business administration, IT or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required

5 years of work experience in business analysis, project management, and/or process improvement to include:

3 years of functional experience in at least one of the specific areas for position (e.g., compliance, claims, eligibility, product, benefits, implementations or related area)

Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Proven client service skills with a track record for building strong client relations

Implementation experience

Self learns new processes/software to solve analytic problems

Expert interpersonal skills necessary to drive results and deliver on commitments in a collaborative fashion

Skillful at meeting facilitation, conflict management, and consensus building

Capable of handling multiple projects simultaneously and ability to work under pressure with strict timelines in a fast-paced work environment

Excellent verbal and written communication skills with prior experience giving presentations

Proficiency in Microsoft Word, Excel, Project, PowerPoint, and Visio

Preferred Qualifications

6 years of progressive work experience in legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated industry, including experience with Medicaid, the Affordable Care Act (ACA) and government programs

Previous PBM or healthcare experience

Legal and/or regulatory experience working with new/proposed and final State and Federal regulatory laws, guidance, and regulations

Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC)

Certified Project Management Professional (PMP)

Expert communication, negotiation and influencing skills

Minimum Physical Job Requirements

Occasional non-standard hours and travel may be required

Constantly required to sit, use hands to handle or feel, talk and hear

Frequently required to reach with hands and arms

Occasionally required to stand, walk and stoop, kneel, and crouch

Occasionally required to lift and/or move up to 10 pounds

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to a Functional Business Owner, Manager or Director in PBM Operations, Specialty Operations, Clinical Operations, Compliance, Finance or Supply Chain Shared Services

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

R-13802