Hybrid Compliance Analyst Sr chez AmeriHealth Caritas

Job Summary

The Compliance Analyst, Sr. will be responsible for assisting with implementation of the seven elements of the compliance program and supporting elements of Prevention Detection, and Correction across Compliance functions. Specific involvement in the Compliance Program shall include the primary key accountabilities listed below. Other duties will be assigned as deemed necessary to support Compliance priorities.

Work Arrangement

Hybrid 2-3 days a week at our Newtown Square, PA headquarters. 

Essential Functions

Policy and Procedure Development

• Supports the review and revision process of policies, procedures, and practices designed to make sure the business is in compliance with the contract and state and federal laws and regulations at the direction of the Compliance Director.
• Maintains documentation of policies, procedures and practices.
• Supports tool and capability development and maintenance.

Compliance Oversight

• Accountable for documentation of all regulatory issued memos, notices, bulletins, contractual requirements, reports and regulatory requests to promote effective and timely communication to associates, contractors, and subcontractor-vendors and timely responses.
• Attends state meeting (public and state in-person or online), takes notes, gathers materials needed for the meeting from internal business owners, coordinates with internal business owners to submit follow-up materials.
• Supports the Compliance Committees by scheduling meetings, preparing documents, and presenting at the direction of the Compliance Director. 
• Leads/supports development of annual work plans and execution of work plan activities. 
• Leads/supports risk assessment development and analysis. · Leads and/or perform contract/regulatory research as needed.

Education, Training and Requirements

• Assists Compliance Director with the developmental, implementation and monitoring of the LOB compliance training, education, and communication programs.
• Monitors and tracks compliance with contractual education and training programs.
• Supports development and maintenance of tools and capabilities.
• Assist and/or leads activities related to the completion of requirements (e.g., Code of Conduct, Conflict of Interest, etc.,).

Communications and Leadership Cadence

• Supports execution of communications and engagement strategy including but not limited to; drafting of communications, development and maintenance of communication channels and supporting Compliance events.
• Responsible for monitoring compliance communication tools and timely responses to inquiries and request for technical assistance to promote open lines of communication with associates, contractors, and subcontractor-vendors.
• Supports leadership focused meetings and forums including; planning, production of materials, support of event logistics and any other needs identified.

Reporting, Investigating, Monitoring and Auditing

• Assists and/or leads compliance monitoring and auditing activities to ensure contract compliance.
• Assists and/or leads documenting process gaps, weaknesses and deficiencies, and issues corrective actions as appropriate to document root cause and remediation(s).
• Assists with responses to Request for Information and responses to internal and external audits.
• Assists and/or leads compliance assessments/reviews to test established and newly executed operational processes and controls.
• Assists and/or leads support of Plan level audits and focused reviews, including but not limited to identifying, gathering, and organizing Plan level documentation and organizing meetings Plan staff.

Enforcement and Disciplinary Actions

• Supports disciplinary actions requested by Compliance Officer, Compliance Committee, and/or executive leadership.

Corrective Actions

• Documents corrective action plans identified through audits, monitoring departmental performance indicators, or by recommendation of business owner, management or the Board of Directors.
• Supports the management of corrective actions throughout lifecycle.
• Assists and/or leads key monitoring, reporting and or facilitation of forums focused on Corrective Action reviews.

Education/Experience:

• Bachelor’s Degree: Bachelor's degree or equivalent education.
• Preferred Experience Level (if different from minimum required): at least three (3) to five (5) years of experience in managed health care.
• 3 or more years in a managed health care environment, including experience in the areas of compliance oversight.

Other Skills:

• Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.
• Demonstrates knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication)
• Self-motivated with demonstrated project management skills.
• Demonstrates strong knowledge of Microsoft Office and SharePoint
• Efficient facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
• Strong problem solving and critical thinking skills.
• Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.
• Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.
• Acts independently and requires minimal supervision, proactively takes initiative.
• Process development and process management knowledge/demonstrated abilities.
• Continuous Improvement mindset; ability to identify and apply improvements.
• Ability to understand contract and regulatory language, prior experience a plus.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.