Senior Compliance Analyst (Medicare/Medicaid) - Remote

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Senior Compliance Analyst (Medicare/Medicaid) - Remote

Job Description

Responsibilities

• Execute compliance procedures and enforce policy governance to validate regulatory reporting and operational requirements are met
• Serve as a compliance subject matter expert and develop solutions to highly complex issues; enhance supporting documentation
• Represent Compliance on complex contracts and cross-functional projects and establish effective stakeholder partnerships
• Lead project management for highly sensitive or complex compliance initiatives
• Prepare clear and accurate compliance records and executive or governance reporting for senior leaders and committees
• Execute and enhance compliance programs, training, conflict of interest, policy governance, and cyclical compliance processes
• Research and interpret laws, guidance, regulatory issues, and filing requirements; document and escalate findings
• Manage assigned licensing submissions, filings, renewals, reporting, source documentation, procedures, and tools
• 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 from an accredited school or equivalent GED 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 the need for work visa or residency sponsorship

Additional Qualifications

• Exceptional written and verbal communication skills
• Critical thinking and problem-solving skills for highly complex situations
• Comprehensive understanding of effective compliance program principles, practices, standards, industry challenges, and emerging approaches
• Ability to present complex information and influence stakeholders at all organizational levels
• Advanced organization and analytical skills with ability to manage multiple projects simultaneously

Preferred Qualifications

• PBM or healthcare experience
• Certified Compliance and Ethics Professional (CCEP) or Certified in Healthcare Compliance (CHC)
• Project Management Professional (PMP)
• Medicare Part D, Medicaid, and/or Affordable Care Act experience
• Advanced degree in a related area of study, such as Juris Doctor
• Licensing application maintenance, tracking, renewal, and submission experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

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, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local 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.