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Compliance Operations Analyst

Company: Amerihealth
Location: Raleigh
Posted on: September 12, 2021

Job Description:

Your career starts now. We’re looking for the next generation of health care leaders.

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 www.amerihealthcaritas.com.

Responsibilities:

The Compliance Operations Analyst will assist the Director of Compliance for AmeriHealth Caritas Next, a Federally Qualified Health Plan (FQHP) located in North Carolina, in establishing and maintaining compliance with all applicable requirements and obligations, including state and federal rules, regulations, standards, and Marketplace requirements, and in maintaining and observing the highest standards of ethical conduct in the Plan’s business and operational practices.  

In addition, this position includes the following specific job duties (which should be considered a non-exhaustive list): 

  • Supports oversight of the FQHP's compliance with program requirements. 
  • Supports the Plan in implementing policies, procedures, and practices designed to ensure compliance with the requirements of the Marketplace. 
  • Assists with Investigating, documenting, tracking and responding to compliance issues, and enforcing corrective actions in order to address offenses and working on specific compliance-related projects as designated by the Compliance Director. 
  • Assists in the development and implementation of compliance policy, procedures, and process and control activities.
  • Assists with development of compliance methodologies to test established and newly executed operational processes and controls and monitor effectiveness.
  • Assists with developing and monitoring compliance training and education programs. 
  • Assists the Director of Compliance with conducting ad-hoc compliance assessments/research as requested, and ensures that local compliance related issues and risks are identified, aggregated, and reported.
  • Assists with coordinating internal and external audit activities, and helps ensure responses to audit findings or conclusions are properly implemented by business process owners in a timely manner.
  • Supports the Compliance Officer in preparing for FQHP Compliance Committee meetings, including ensuring that all required compliance committee meetings are scheduled, held, and minutes taken of the same. 
     

Education/Experience:

  • Bachelor’s Degree.
  • Strong research, writing and interpersonal skills. 
  • Strong oral and written communication skills.
  • Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
  • Strong interpersonal skills.
  • Innovative and creative. Able to embrace change and think outside the box.
  • Strong problem solving and critical thinking skills.
  • Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.
  • Strong organizational skills, with the ability to apply good judgment and resolve ambiguities. 
  • Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication)
  • Self-motivated with demonstrated project management skills.
  • Acts independently and requires minimal supervision.
  • Demonstrates a general understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines associated with FQHPs.
  • Proactive, can-do attitude and work ethic
  • Strong analytic skills, with ability to identify process gaps, weaknesses and deficiencies and/or business productivity/efficiency opportunities.
  • Knowledge of governmental and/or health plan products (MAO, MCO, etc.) with preference of evidenced FQHP compliance operations experience.

Keywords: Amerihealth, Raleigh , Compliance Operations Analyst, Other , Raleigh, North Carolina

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