Compliance Analyst

This position will require an individual with strong clinical understanding. No license is required, however must understand CMS regulations, health risk assessments and corrective actions for Medicare. Will need an understanding of the 7 elements of compliance.

Reporting, Investigating, Monitoring and Auditing

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.

Assist with conducting plan level audits and focused reviews, including but not limited to identifying, gathering and organizing plan level documentation and organizing meetings plan staff.

Assist with conducting compliance assessments/reviews to test established and newly executed operational processes and controls.

Enforcement and Disciplinary Actions

Supports disciplinary actions requested by Compliance Director, Compliance Committee, and/or executive leadership.

Corrective Actions

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.

Additional Compliance teams have primary focus on areas listed below. However, this position may provide support for these functions.

Policy and Procedure Development

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.

Compliance Oversight

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.

Education, Training and Requirements

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.,).

Communications

Responsible for monitoring compliance communication tools and timely responses to inquiries and request for technical assistance to promote open lines of communication with associates, contractors, and subcontractor-vendors.

Experience and Background

Education/Experience:

Bachelor’s Degree preferred or equivalent experience or education

Preferred Experience Level (if different from minimum required): at least one to three (1 to 3) years of experience in managed health care including experience in the areas of compliance oversight.

Other Skills:

Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.

Demonstrates knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication)

Self-motivated with demonstrated project management skills.

Demonstrates strong knowledge of Microsoft Office and SharePoint.

Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.

Strong problem solving and critical thinking skills.

Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.

Acts independently and requires minimal supervision, proactively takes initiative.

Process development and process management knowledge.

Continuous Improvement mindset; ability to identify and apply improvements.

Ability to understand contract and regulatory language, prior experience a plus.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.