Senior Compliance Analyst (Medicare/Medicaid) - Remote
$74k - $118kPrime Therapeutics
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Senior Compliance Analyst (Medicare/Medicaid) - Remote Job Description The Senior Compliance Analyst leads compliance initiatives within assigned areas and supports implementation of enterprise compliance programs. This role manages sensitive projects, serves as a subject matter expert, interprets complex requirements, develops executive reporting, and partners across the organization to maintain effective compliance, governance, and licensing processes. Responsibilities Execute compliance procedures and enforce policy governance to validate regulatory reporting and operational requirements are met. Serve as a compliance subject matter expert and develop solutions to highly complex issues; enhance supporting documentation. Represent Compliance on complex contracts and cross-functional projects and establish effective stakeholder partnerships. Lead project management for highly sensitive or complex compliance initiatives. Prepare clear and accurate compliance records and executive or governance reporting for senior leaders and committees. Execute and enhance compliance programs, training, conflict of interest, policy governance, and cyclical compliance processes. Research and interpret laws, guidance, regulatory issues, and filing requirements; document and escalade findings. Manage assigned licensing submissions, filings, renewals, reporting, source documentation, procedures, and tools. Other duties as assigned. Minimum Qualifications Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required 5 years of progressive work experience in legal or compliance related roles for a healthcare or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid, and the Affordable Care Act (ACA). Must be eligible to work in the United States without the need for work visa or residency sponsorship. Additional Qualifications Exceptional written and verbal communication skills. Critical thinking and problem-solving skills for highly complex situations. Comprehensive understanding of effective compliance program principles, practices, standards, industry challenges, and emerging approaches. Ability to present complex information and influence stakeholders at all organizational levels. Advanced organization and analytical skills with ability to manage multiple projects simultaneously. Preferred Qualifications PBM or healthcare experience. Certified Compliance and Ethics Professional (CCEP) or Certified in Healthcare Compliance (CHC). Project Management Professional (PMP) Medicare Part D, Medicaid, and/or Affordable Care Act experience. Advanced degree in a related area of study, such as Juris Doctor Licensing application maintenance, tracking, renewal, and submission experience. 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. Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills. Prime Therapeutics LLCis 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 (including pregnancy), 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. At Prime Therapeutics (Prime), we are a different kind of PBM. We’re reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference. We know that people make all the difference. #J-18808-Ljbffr
$74k - $118k
...serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Senior Compliance Analyst (Medicare/Medicaid) - Remote Job Description The Senior Compliance Analyst leads compliance initiatives within assigned areas and...Remote workSeniorFull timeWork experience placementLocal areaVisa sponsorshipWork visa- ...Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to inquiries from health plans... ...ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible #J-18808-Ljbffr...Remote workSenior
- ...Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to serve as the subject matter expert for external audits, regulatory... ...candidate brings extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible #J-18808-Ljbffr...Remote workSenior
- ...Gainwell Technologies seeks a Senior Business Analyst for Medicaid to drive business analysis and project coordination on Medicaid/Medicare initiatives. Remote work is available with occasional onsite meetings; the role supports client goals and technology-driven improvements...Remote workSenior
- ...experience as a Java developerCandidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.Candidate should have hands-on experience on claims processing and adjudication processes.Experience with user interface design...Remote workSeniorWork experience placement
$71.74k - $129.64k
...Own corporate compliance and Medicare/Medicaid obligations, reporting to the SVP of Legal. Support HIPAA, delegation, and federal healthcare program... ...is a Series B stage company backed by leading investors, with a remote-first, distributed workforce. #J-18808-Ljbffr...Remote workSenior- ...seeking an Advanced Reimbursement Analyst to identify and collect underpayments from Medicare/Medicaid and other payors, ensuring... ...accurate documentation and contract compliance. The role is hybrid, with two... ...El Segundo, CA and three days remote. You will review payments,...Remote workSeniorContract work
- ...Prime Therapeutics is hiring a Senior Clinical Pharmacy Technician Sr - MCO Clinical Liaison - Remote to support NY Medicaid. The role focuses on handling complex coordination... ...will assist with case reviews, maintain compliance with guidelines, and collaborate with internal...Remote workSenior
$90k
...The Senior Utilization Management Audit & Compliance Analyst serves as the subject matter expert for external customer... ...Utilization Management experience across Medicare, Medicaid, Commercial, and Dual Eligible... ...development opportunities Remote Opportunities We are...Remote workSeniorTemporary workLocal area- ...Scion Staffing, Inc. is seeking a Senior DME Billing Specialist for a healthcare organization. This fully remote role supports Missouri/Arkansas candidates and may require... ..., and focus on MO HealthNet and Missouri Medicaid programs. Collaboration with multiple teams will...Remote workSenior
$86.3k - $118.7k
...a part of our caring community The Senior Compliance Professional for Medicaid ensures compliance with governmental... ...business needs. This role is fully remote within the U.S. Work at Home... ...better quality of life for people with Medicare and Medicaid, families, individuals...Remote workSeniorFull timeContract workTemporary workApprenticeshipWork at officeWork from homeHome office- ...Gainwell Technologies is seeking a Senior Manager, Drug Rebate Product to own the strategic direction and delivery of Medicaid Drug Rebate solutions. You will guide priorities and collaborate across product, development, testing, implementation, and operations teams to...Remote workSenior
- ...Gainwell Technologies is seeking a Senior Manager, Pharmacy and Drug Rebate Services to lead strategic Medicaid Drug Rebate solutions. You will guide priorities, coordinate... ...practical, high-impact results. In this remote role, you will drive efficiency, usability, and...Remote workSenior
- ...Mathematica is seeking a Senior Fellow - Medicaid (Remote Eligible) to lead research and policy work on Medicaid and CHIP at national levels. You will guide policy development, oversee projects, and represent Mathematica to clients and external audiences. The role...Remote workSenior
- ...What You'll Be Doing: Investigate complex AML cases and track suspicious blockchain transactions. Collaborate with compliance, law enforcement, and external partners. What We Look For In You: ~3-5 years of BSA/AML investigations and transaction...Remote workSenior
- 100% Remote Please Apply Only If You Have 3 Years Experience Completing Medicare and Medicaid Payer Credentialing Applications AIS Healthcare is the leading provider of Targeted... ...platforms and payer applications Support compliance with regulatory, accreditation, and...Remote workContract workWork from home
- ...BerryDunn’s Health Analytics Practice Group is seeking a Senior Consulting Actuary to apply actuarial expertise to Medicaid policy, financing, and program evaluation. You... ...offers flexible locations (onsite, hybrid, or remote) with a preference for Hawaiʻi or the U.S. #J-188...Remote workSeniorFlexible hours
$103k - $107k
Pacific Staffing is recruiting a Senior Compliance Analyst for a leading Sacramento based financial institution known for its regulatory discipline... ...compliance standards. Hybrid after training ( 2 days remote): Sacramento, CASalary: $103,000 - $107,000 (DOE) Key Responsibilities...Remote workSeniorWork at office- ...Gainwell Technologies is seeking a Senior Drug Rebate Quality Assurance to lead QA for Medicaid Drug Rebate solutions. You will... ...quality strategies, ensuring compliance with standards and guiding... ...delivering product excellence in a remote-friendly #J-18808-LjbffrRemote workSenior
- ...Random Bit is seeking an experienced Business Analyst to work with Enterprise Architects on... ...modernization planning, focusing on Medicaid domain. You will analyze business processes... ...documentation, and stakeholder engagement, with remote work possible but EST hours (8am-5pm)....Remote workSeniorFull time
- ...Gainwell Technologies is seeking a Senior Medicaid Systems Operations Manager to lead a 30+ team ensuring MMIS and related healthcare platforms... ..., release coordination, and vendor management in a US-wide remote capacity. The ideal candidate has 7–10+ years in IT...Remote workSenior
- ...Leading the implementation and ongoing maintenance of the ISO/IEC 27001:2022 program, the full-time remote Senior Compliance Analyst will serve as the primary subject matter expert, collaborating with cross-functional teams to manage compliance activities, coordinate...Remote workSeniorFull time
- ...personable yet professional Senior Project Manager to work with... ...hybrid, leaning more or the remote side, but the most qualified... ...primary liaison between state Medicaid agencies, federal partners (CMS... ...vendor deliverables, ensuring compliance with service level agreements...Remote workSeniorContract workFlexible hours
$69.4k - $99.2k
...Gainwell Technologies is seeking a Senior Medicaid Business Analyst to translate state and federal Medicaid policy into product features, system configuration... ...delivery, and collaboration with client teams; fully remote options available and compensation range $69,400-$99,200...Remote workSenior- ...Gainwell Technologies is seeking a Senior Business Analyst - Medicaid who will bridge business needs and technology to improve health outcomes for clients. You will collaborate with project managers, clients and technical teams to define requirements and deliverables...Remote workSenior
- ...Gainwell Technologies is seeking a Senior Medicaid Business Analyst (Configuration & Policy) to translate state and federal Medicaid policy into product features and configurations. You will support domain delivery end-to-end, collaborating with Domain Lead, Technical...Remote workSenior
- Responsibilities include administering compliance tools, handling inquiries, and assisting with training, disclosures, and corrective actions. Strong communication and analytics skills are essential for success in this role. #J-18808-LjbffrRemote workSenior
- ...Gainwell Technologies LLC is seeking a Senior Manager, Drug Rebate Product to drive the strategic direction and delivery of Medicaid Drug Rebate solutions. You will guide priorities... ...operations teams. This role is 100% remote with up to 20% travel for client meetings....Remote workSenior
$85k - $100k
...applications and next steps. Our partner is looking for a Senior Compliance Analyst – Advertising Review based in the United States. The Senior... ...requirements, internal policies, and industry standards. In this remote position, you will review advertising and marketing...Remote workSeniorFlexible hours- ...Gainwell Technologies LLC is seeking a Senior Business Analyst for Medicaid Claims & Eligibility to drive requirements, process improvements, and successful... ...with Excel/SQL and ALM tools. This is a fully remote position across the U.S., with competitive benefits and...Remote workSenior
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Compliance Analyst (Medicare/Medicaid) - Remote. Be the first to apply!
- trade compliance specialist New York, NY
- legal compliance analyst New York, NY
- compliance officer New York, NY
- coding compliance specialist New York, NY
- research compliance officer New York, NY
- regulatory operations specialist New York, NY
- compliance analyst New York, NY
- legal compliance officer New York, NY
- regulatory specialist New York, NY
- healthcare compliance officer New York, NY



