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Years of Experience
Date Last Verified
ProfileCompliance Analyst Responsibilities: Executes compliance procedures and enforces policy governance across the organization to validate requirements are met and that business operations are aligned with expectations of applicable regulatory guidance. Develop solutions to compliance problems by referring to precedence, policies and standard operating procedures; escalate issues to Compliance leadership as appropriate. Support and at times, lead the project management efforts of Compliance initiatives. Represent the Compliance Department on projects of medium complexity, contracts or other cross-functional assignments. May execute Prime’s compliance programs by facilitating the development, maintenance and delivery of compliance training, administering the annual conflict of interest process, or completing regular review of standard operating procedures and policies; may develop annual revision and tracking process for policies and procedures. Research 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 (PBM, PPA, TPA, UR, 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, DTPs, and Licensing source documentation, participate in ongoing departmental process improvement activities, and respond to departmental emails received. May also manage the licensing IT application and conduct general maintenance of that tool. Other duties as assigned.
Qualification and Experience
Qualifications: Bachelor’s degree in business or healthcare, or JD Degree, or related area of study, or equivalent combination of education and/or relevant work experience. 2 years experience within legal or compliance related positions, or 3 years' experience in a project or program coordination role within a highly regulated industry. Strong written and oral communication skills. Ability to apply critical thinking skills and problem solve through complex situations. Thorough understanding of effective compliance program principles, concepts, practices and standards. 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. Preferred: PBM/health care experience. Medicare Part D/Medicaid/ACA experience. Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC). Certified Project Management Professional (PMP). If working within Licensing, previous experience maintaining, tracking, renewing and submitting applications for licensure. Certified Project Management Professional (PMP).