Senior Compliance Analyst (Regulatory Compliants & Inquires) - Remote

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Senior Compliance Analyst (Regulatory Compliants & Inquires) - Remote

Job Description

The Regulatory Inquiry & Complaints Senior Compliance Analyst assists in the implementation of Prime’s compliance programs and may lead some initiatives within their designated areas and partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, licensure, and program manuals are effectively followed and/or maintained. Works independently to research and resolve regulatory inquiries/complaints related to claims, contracting and XXXX. Works directly with business partners across the enterprise.

Responsibilities

• Executes compliance procedures and enforces policy governance across the organization to validate regulatory 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
• Lead project management efforts for highly sensitive Compliance initiatives
• Represents the Compliance Department on complex contracts or cross-functional projects; identifies key stakeholders from across the enterprise and establishes effective collaboration techniques to maintain ongoing partnership between functions
• Serves as subject matter expert within Compliance and develops solutions to highly complex compliance problems by referring to precedence, policies and standard operating procedures; escalate issues to Compliance leadership as appropriate and enhance or develop new supporting documentation as necessary
• Research and interpret laws, industry guidance and regulatory issues that impact Prime’s compliance programs or business operations; document requirements or disciplinary actions and escalate findings as appropriate
• Other duties as assigned
  
  

Minimum Qualifications

• Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 5 years of progressive work experience in legal or compliance related roles for a healthcare or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid, and the Affordable Care Act (ACA)
• Must be eligible to work in the United States without need for work visa or residency sponsorship
  
  

Additional Qualifications

• Exceptional written and oral communication skills
• Demonstrated ability to apply critical thinking skills and problem solve through highly complex situations
• Complete understanding of effective compliance program principles, concepts, practices and standards; full breadth of knowledge around industry best practices and challenges; experience developing new concepts, techniques, standards and programs to support an organization’s compliance priorities
• 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
• Strong analytical skills
• If working within Licensing, experience maintaining, tracking, renewing and submitting applications for licensure
  
  

Preferred Qualifications

• PBM/health care experience
• Commercial/Medicare Part D/Medicaid/ACA experience
• Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC)
  
  

Minimum Physical Job Requirements

• Ability to travel up to 10% of the time
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
  
  

Reporting Structure

• Reports to Sr Professional, Manager, Director or Senior Director in the Compliance department
  
  

Potential pay for this position ranges from $74,500.00 - $111,700.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.