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Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is a leading health care solutions provider dedicated to helping people get care, stay well, and build healthy communities. The Compliance Analyst supports the implementation of compliance programs including policy development, compliance oversight, and Code of Conduct investigations. This role involves reviewing compliance activities, supporting risk assessments, and assisting with documentation and reporting to ensure regulatory compliance in a managed healthcare environment.
Responsibilities
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
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
Supports the Compliance Committees by scheduling meetings, preparing documents, and presenting at the direction of the Compliance Director
Supports development of annual work plans and execution of work plan activities
Supports risk assessment development and analysis
Leads and/or perform contract/regulatory research as needed
Monitors and tracks compliance with contractual education and training programs
Assist and/or leads activities and investigations related to the completion of requirements (e.g., Code of Conduct, Conflict of Interest, etc.)
Responsible for monitoring compliance communication tools and timely responses to inquiries and requests for technical assistance to promote open lines of communication with associates, contractors, and subcontractor-vendors
Assist with compliance monitoring and auditing activities to ensure contract compliance
Assist with 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
Supports compliance-related reviews, including Code of Conduct investigations and Data Loss Prevention cases, by reviewing applicable documents, policies, procedures, and related information to identify issues and support appropriate follow-up
Assist with conducting compliance assessments/reviews to test established and newly executed operational processes and controls
Assist with conducting Plan-level audits and focused reviews, including but not limited to identifying, gathering, and organizing Plan-level documentation and organizing meetings with Plan staff
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 Compliance Director with the management of State-initiated corrective actions
Skills
High School Diploma or GED required
Minimum of 1 year of experience in a managed health care environment, including experience in the areas of compliance oversight
Bachelor's Degree preferred or equivalent combination of education and experience
Prior compliance, managed care, regulatory, or investigative support experience preferred
Proficiency in Microsoft Excel and/or Microsoft Access preferred
Benefits
Flexible work solutions including remote options
Hybrid work schedules
Paid time off including holidays and volunteer events
Health insurance coverage for you and your dependents on Day 1
401(k)
Tuition reimbursement
Company Overview
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill. It was founded in 1982, and is headquartered in Philadelphia, Pennsylvania, USA, with a workforce of 10001+ employees. Its website is http://www.amerihealthcaritas.com.
