| Urgent Hiring on :: CMS Compliance Subject Matter Expert :: Remote at Remote, Remote, USA |
| Email: [email protected] |
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From: Sankhi Tudu, Vyze Inc [email protected] Reply to: [email protected] Title: CMS Compliance Subject Matter Expert Location: Remote (New York and Boston,) (EST) Duration: 6+ weeks Visa: USC/GC Moi: Video We are seeking a highly skilled CMS Compliance Subject Matter Expert (SME) to ensure adherence to CMS regulations and guidelines. This role requires deep expertise in regulatory requirements, risk management, and policy implementation to support compliance efforts within the healthcare sector. The CMS Compliance SME will play a crucial role in audits, process improvement, and risk mitigation to maintain regulatory adherence and drive continuous improvement in healthcare compliance. Our vision is to create a differentiated PBM system, transforming pharmacy benefit management with innovative technology, real-time insights, and outcome-focused solutions to ensure: Affordable access, Seamless experiences, and Improved health outcomes. Healthcare & Pharmacy Benefit Management (PBM): The healthcare industry, particularly Pharmacy Benefit Management (PBM), is evolving to enhance patient care and cost efficiency. PBM plays a crucial role in managing prescription drug benefits, optimizing medication access, and ensuring regulatory compliance. This role will contribute to the advancement of PBM solutions by maintaining strict adherence to CMS regulations, streamlining processes, and improving healthcare outcomes. Should have: 10+ years of experience in healthcare compliance, with a focus on CMS regulations for PBM platforms Strong knowledge of CMS regulations impacting PBM platform development, including Medicare Part D, Medicaid, ACA, and HIPAA Proven experience integrating regulatory compliance into software development, APIs, and platform workflows Expertise in CMS audit processes, compliance automation, and regulatory-driven technology solutions Ability to translate CMS policies into platform features and development roadmaps Strong collaboration skills with engineering, product, and regulatory teams Preferred certifications: CHC (Certified in Healthcare Compliance), CPC (Certified Professional Coder), or relevant healthcare IT certifications Strong interpersonal and communication skills Responsibilities: Regulatory Compliance in Platform Design: Ensure PBM platform development aligns with CMS regulations for Medicare Part D, Medicaid, ACA, and HIPAA Compliance by Design: Work with engineering and product teams to embed CMS requirements into platform architecture, APIs, and automated workflows Regulatory Interpretation: Translate CMS guidelines and policy changes into technical and functional platform requirements Continuous Regulatory Monitoring: Track CMS updates, assess their impact on the platform, and drive necessary system enhancements Audit & Reporting Automation: Define compliance-driven reporting capabilities within the platform, ensuring automated audit readiness Stakeholder Collaboration: Partner with engineering, product management, legal, and client teams to integrate compliance controls into platform development Risk Mitigation in System Design: Identify regulatory risks in the PBM platforms architecture and propose corrective design measures Process Standardization: Establish best practices for compliance workflows, ensuring adherence to CMS technical and security standards Training & Documentation: Educate internal teams on compliance-driven development and maintain regulatory documentation for audits and stakeholders Keywords: information technology green card Urgent Hiring on :: CMS Compliance Subject Matter Expert :: Remote [email protected] |
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| 09:07 PM 26-Feb-25 |