Senior Functional Business Consultant- REMOTE

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- 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 visio