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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 Philadelphia, 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 [ Link removed ] - Click here to apply to Government Compliance Oversight & Risk Analyst.
The Risk Analyst will assist the Manager, Oversight & Risk Management in ensuring the audit and oversight of internal operations and downstream entities’ compliance with state and federal regulations. This includes auditing and monitoring of the business units, and monitoring of First Tier, Downstream and Related Entities (FDRs) and subcontractor-vendors to ensure effective ongoing regulatory compliance. The incumbent will assist the Manager in the oversight of the issuance of Corrective Action Plans (CAPs) when issues of non-compliance are identified and ensures effective tracking of audit outcomes and CAPs. The incumbent will assist in the oversight of Client Audit activities within the organization, and will work with the organization on the identification of organizational risk and annual development of the Risk Assessment. The Analyst’s primary responsibility is to serve with the Manager in the compliance oversight of the compliance of internal operations and downstream entities’ with state and federal regulations through monitoring of metrics based on regulatory guidance and service level agreements. Additionally, the Analyst receives and coordinates internally all responses to client audit notices. The Analyst will prepare periodic reports to senior management, which includes communication of the results of audit and oversight activities to ensure effective ongoing regulatory compliance.
Specific Responsibilities include the following:
Maintain a thorough and comprehensive understanding of plan business practices to effectively assess the impact of regulatory requirements
Oversee development and implementation of and monitor adherence to corrective action plans
Manage site visit preparation process and coordinate annual audits of FDRs; coordinate client audit requests; review results of audits and work with clients and internal departments/FDRs to develop and implement corrective actions
Participate in the development and implementation of compliance metrics for relevant business units
Monitor metrics on a monthly basis and work with business units to improve compliance metric performance to include issuance of Corrective Action Plans if indicated
Work with the Compliance Officer and Compliance Committee to coordinate the Risk Assessment process
Represent compliance area on ad hoc teams as needed
Bachelor’s Degree in Business or equivalent field required; equivalent combination of experience and education will be considered
Minimum two (2) years’ experience in a private and/or public sector regulatory agency compliance position required
Minimum two (2) years’ experience working in or with a Pharmacy Benefits Manager (PBM) preferred
Minimum five (5) years' experience with managed care, Medicare and/or Medicaid programs required
Regulatory and operational compliance and audit experience highly preferred
Extensive knowledge of federal and state regulations required
Experience in a pharmacy and/or Pharmacy Benefits Manager (PBM) environment helpful
Excellent verbal, written and presentation skills
Strong PC skills including experience with MS Project, MS Office, MS Outlook, or equivalent
Ability to exercise professional judgment in analyzing and resolving issues
Demonstrates personal traits of a high level of integrity, professionalism, and trustworthiness
Places a high value on ethical standards and treating others with dignity and respect
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Job ID: PGM-CC-7055_21256
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