Job Details

Role Overview: The Compliance Analyst will be responsible for assisting with implementing the seven elements of the compliance program and supporting aspects of Prevention, Detection, and Correction across Compliance functions. Specific involvement in the Compliance Program shall include the primary key accountabilities listed below. Other duties will be assigned as deemed necessary. This position will support the Ohio line of business.

Work Arrangement:

• This is a remote position for an Ohio resident. On rare occasions, this position may require a visit to the Columbus area office for audits.

Responsibilities include the seven components of compliance:

Reporting, Investigating, Monitoring, and Auditing

• Assist with compliance monitoring and auditing activities to ensure contract compliance.
• Assist with documenting process gaps, weaknesses, deficiencies, issues, and corrective actions to document root cause and remediation(s).
• Assist with conducting plan-level audits and focused reviews, including but not limited to identifying, gathering, and organizing plan-level documentation, and organizing meeting plans for staff.

Enforcement and Disciplinary Actions

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

Corrective Actions

• Documents corrective action plans identified through audits, monitoring departmental performance indicators, or by recommendation of the business owner, management, or the Board of Directors.
• Supports the Compliance Director with the management of state-initiated corrective actions.

Policy and Procedure Development

• Supports the review and revision process of policies, procedures, and practices designed to ensure the business complies 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, subcontractor-vendors, and timely responses.
• Supports risk assessment development and analysis.
• Leads and/or performs contract/regulatory research as needed.

Communications

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

Education and Experience:

• A bachelor's degree or equivalent experience or education is preferred.
• Preferred experience level: at least 3 years of experience in healthcare compliance.

Our Comprehensive Benefits Package

Flexible work solutions include 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.

At AmeriHealth Caritas, we are 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 would like to connect with you.

Headquartered in Newtown Square, PA, 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.

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.