Compliance Analyst, Risk, Audit, Monitoring

Role Overview

• Design and/or enhance targeted and annual risk assessments
• Develop risk methodologies, scoring, and prioritization
• Construct specific and effective auditing and monitoring workplans based on risks identified
• Perform timely auditing and monitoring activities
• Analyze compliance outcomes and ensure detected issues are referred for remediation
• Identify ways to mitigate risks to our organization
• Coordinate external audits, as assigned
• Create and run mock audits
• Build and perform readiness testing exercises
• 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
• Perform root-cause analysis and identify prevention, detection, and correction opportunities
• Ensure business partners complete corrective actions in a timely and effective manner
• 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 audit and monitoring activities, compliance risk assessments
• 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

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary Paid Time Off
• Paid Company Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities