Senior Compliance Analyst – Medicare/Medicaid

🕒 6 days ago

🇺🇸 United States – Remote

💵 $74k - $118k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Execute compliance procedures and enforce policy governance to validate regulatory reporting and operational requirements • Serve as a compliance subject matter expert and develop solutions to highly complex issues • Enhance supporting documentation • Represent Compliance on complex contracts and cross-functional projects • Establish effective stakeholder partnerships • Lead project management for highly sensitive or complex compliance initiatives • Prepare clear and accurate compliance records and executive or governance reporting for senior leaders and committees • Execute and enhance compliance programs, training, conflict of interest, policy governance, and cyclical compliance processes • Research and interpret laws, guidance, regulatory issues, and filing requirements • Document and escalate findings • Manage assigned licensing submissions, filings, renewals, reporting, source documentation, procedures, and tools • Perform other duties as assigned • Comply with job-specific security responsibilities, legal, regulatory, contractual, and internal policy requirements

🎯 Requirements

• Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience • High school diploma from an accredited school or equivalent GED required • 5 years of progressive work experience in legal or compliance-related roles for a healthcare or PBM organization, or another highly regulated industry • Experience with Medicare, Medicaid, and the Affordable Care Act (ACA) • Must be eligible to work in the United States without work visa or residency sponsorship • Exceptional written and verbal communication skills • Critical thinking and problem-solving skills for highly complex situations • Comprehensive understanding of compliance program principles, practices, standards, industry challenges, and emerging approaches • Ability to present complex information and influence stakeholders at all organizational levels • Advanced organization and analytical skills; ability to manage multiple projects simultaneously • Preferred: PBM or healthcare experience • Preferred: Certified Compliance and Ethics Professional (CCEP) or Certified in Healthcare Compliance (CHC) • Preferred: Project Management Professional (PMP) • Preferred: Medicare Part D, Medicaid, and/or Affordable Care Act experience • Preferred: Advanced degree in a related area of study, such as Juris Doctor • Preferred: Licensing application maintenance, tracking, renewal, and submission experience

🏖️ Benefits

• Benefits, incentives, and additional compensation (details provided via the employer’s Benefits Page) • Equal opportunity and affirmative action employer • Reasonable accommodations for employees with disabilities • Tobacco-free workplace

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