Compliance Analyst - Corrections

Responsibilities

• Design and/or enhance corrective action process
• Assess and prioritize corrective action referrals
• Initiate corrective actions (e.g., corrective action plans, warning letters)
• Collaborate with business stakeholders to perform root cause analysis
• Collaborate with business stakeholders to identify prevention, detection, and correction opportunities
• Ensure business partners complete corrective actions in a timely and effective manner
• Identify ways to mitigate risks to our organization
• Develop job aids, playbook, and other program documentation
• Build and maintain positive and strategic relationships with internal and external stakeholders
• Support our compliant and ethical culture
• Assist in developing or updating oversight materials and reporting metrics
• Create and distribute written compliance standards where applicable
• Abide by organization retention standards and version controls
• Collaborate in Compliance training and education needs
• Investigate potential or reported issues of non-compliance
• Monitor organizational disciplinary actions and incentives for consistency, accuracy, and timeliness
• Collaborate with Legal and other stakeholders to interpret regulations
• Other responsibilities as assigned

Requirements

• Bachelor’s degree or higher education in healthcare, compliance, or a related field, or equivalent years of relevant work experience is required
• Minimum of four (4) years of compliance experience at a PBM or health plan, and pharmacy operations oversight or similar experience would be considered
• Direct experience with pharmacy benefits, network, and claims is a bonus
• Certified in Healthcare Compliance (CHC), Certification in Healthcare Privacy Compliance (CHPC), or Certified Compliance and Ethics Professional (CCEP) preferred
• Current, unrestricted clinical or functional business licensure is a bonus (examples: certified pharmacy technician)
• Strong understanding with the seven elements of a highly effective compliance program
• Strong familiarity with PBM-related healthcare operations and/or clinical concepts, practices and procedures is preferred, or similar health plan knowledge will be considered
• Strong working knowledge of healthcare compliance program corrective actions
• Working knowledge of external audit functions and procedures
• Strong familiarity with ERISA, Healthcare Exchange Marketplace (Affordable Care Act), Worker’s Compensation, and Medicare preferred
• Familiarity with pharmacy operations and healthcare benefits
• Data-driven, big-picture thinker, and solutions-oriented
• Professional verbal and written communication skills including proper grammar, construct, and appropriate to the audience
• Advanced organizational, project, and time management skills to prioritize, prepare, and leverage resources and stay on focus
• Ability to work independently and within a team environment
• Ability to establish effective collaborative techniques, such as conflict resolution

Core Competencies

Demonstrates expertise in healthcare compliance, corrective action processes, and risk mitigation strategies. Proficient in developing compliance documentation and fostering collaborative relationships with stakeholders.