Compliance analyst Jobs in Springfield, IL

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Job Posting Title

Compliance Analyst Sr Medical Pharmacy Specialty / Medicare Part B- REMOTE

Job Description

The Senior Compliance Analyst assists in the implementation of Prime’s compliance programs and leads initiatives within their designated areas. This role partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, licensure, and program manuals are effectively followed and maintained.

Responsibilities

Executes compliance procedures and enforces policy governance across the organization to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory guidance

Lead project management efforts for highly sensitive Compliance initiatives

Represents the Compliance Department on complex contracts or cross-functional projects; identifies key stakeholders from across the enterprise and establishes effective collaboration techniques to maintain ongoing partnership between functions

May collect, prepare and maintain records and related documentation for reporting to the Chief Compliance Officer, Prime’s senior leadership team, executives, Corporate Compliance Committee members and the Board of Directors; collaborates across the compliance organization to collect and organize information into clear, accurate and effective executive reports

Serves as subject matter expert within Compliance and develops solutions to highly complex compliance problems by referring to precedence, policies and standard operating procedures; escalate issues to Compliance leadership as appropriate and enhance or develop new supporting documentation as necessary

May execute and enhance Prime’s compliance programs by developing, maintaining and delivering compliance documentation and training, administering the annual conflict of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies

Research and interpret laws, industry guidance and regulatory issues that impact Prime’s compliance programs or Board of Pharmacy and Department of Insurance filings; document requirements or disciplinary actions and escalate findings as appropriate

If supporting licensing efforts, may manage regulatory submissions, filings, renewals, notifications, and periodic reports related to licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile required internal reports, perform research of licensing and reporting requirements, respond to requests for information and proposals, develop / revise / maintain departmental SOPs, Desk Top Procedures, and Licensing source documentation; manage the licensing IT application and conduct general maintenance of the licensing tools

Other duties as assigned

Education & Experience

Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and / or relevant work experience; HS diploma or GED is 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 Advantage and Medicare Part B

Must be eligible to work in the United States without need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

Exceptional written and oral communication skills

Demonstrated ability to apply critical thinking skills and problem solve through highly complex situations

Complete understanding of effective compliance program principles, concepts, practices and standards; full breadth of knowledge around industry best practices and challenges; experience developing new concepts, techniques, standards and programs to support an organization’s compliance priorities

Ability to effectively present complex information to a wide variety of audiences

Ability to establish rapport and effectively influence at all levels within an organization

Enhanced organizational skills with the ability to effectively work on multiple projects simultaneously

Strong analytical skills

If working within Licensing, experience maintaining, tracking, renewing and submitting applications for licensure

Preferred Qualifications

Medical Pharmacy / Specialty drug exp

Health plan experience

Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC)

Certified Project Management Professional (PMP)

Advanced degree in related area of study, such as Juris Doctor

Implementation / Project management experience

Medicare Advantage / Medicare Part B

Physical Demands

Ability to travel up to 10% of the time

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 and occasionally lift and / or move up to 25 pounds

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

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.

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page () and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is 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 (pregnancy, sexual orientation, and gender identity), 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.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is 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 (pregnancy, sexual orientation, and gender identity), 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.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].