Compliance Analyst- COI & Code of Conduct

Amerihealth Caritas•,

2d•Remote

About The Position

The Compliance Analyst will be responsible for assisting with the implementation of the seven elements of the compliance program and supporting elements of Prevention, Detection, and Correction across Compliance functions. This role supports the Compliance team with reviewing and tracking compliance-related activities, responding to inquiries, assisting with Conflict of Interest matters, Code of Conduct investigations, Data Loss Prevention case support, documentation, monitoring, reporting, process improvement, and follow-up activities. Other duties will be assigned as deemed necessary to support Compliance priorities.

Requirements

High School Diploma or GED required.
Minimum of 1 year of experience in a managed health care environment, including experience in the areas of compliance oversight.
Proficiency in Microsoft Excel and/or Microsoft Access preferred.
Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.
Demonstrates knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication).
Demonstrates strong knowledge of Microsoft Office and SharePoint.
Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
Strong problem solving and critical thinking skills.
Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.
Resourceful and able to work independently with minimal supervision, proactively taking initiative when appropriate.
Process development and process management knowledge.
Continuous Improvement mindset; ability to identify and apply improvements.
Ability to understand contract and regulatory language, prior experience a plus.
Strong oral and written communication skills.
Innovative and creative. Able to embrace change and think outside the box.
Models Integrity, Ethics and Values.
Strong interpersonal skills.

Nice To Haves

Bachelor’s Degree preferred or equivalent combination of education and experience.
Prior compliance, managed care, regulatory, or investigative support experience preferred.

Responsibilities

Supports the review and revision process of policies, procedures, and practices designed to make sure the business is in compliance with the contract and state and federal laws and regulations at the direction of the Compliance Director.
Maintains documentation of policies, procedures, and practices.
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, and subcontractor-vendors and timely responses.
Supports the Compliance Committees by scheduling meetings, preparing documents, and presenting at the direction of the Compliance Director.
Supports development of annual work plans and execution of work plan activities.
Supports risk assessment development and analysis.
Leads and/or perform contract/regulatory research as needed.
Monitors and tracks compliance with contractual education and training programs.
Assist and/or leads activities and investigations related to the completion of requirements (e.g., Code of Conduct, Conflict of Interest, etc.)
Responsible for monitoring compliance communication tools and timely responses to inquiries and requests for technical assistance to promote open lines of communication with associates, contractors, and subcontractor-vendors.
Assist with compliance monitoring and auditing activities to ensure contract compliance.
Assist with documenting process gaps, weaknesses and deficiencies, and issues corrective actions as appropriate to document root cause and remediation(s).
Assists with responses to Request for Information and responses to internal and external audits.
Supports compliance-related reviews, including Code of Conduct investigations and Data Loss Prevention cases, by reviewing applicable documents, policies, procedures, and related information to identify issues and support appropriate follow-up.
Assist with conducting compliance assessments/reviews to test established and newly executed operational processes and controls.
Assist with conducting Plan-level audits and focused reviews, including but not limited to identifying, gathering, and organizing Plan-level documentation and organizing meetings with Plan staff.
Supports disciplinary actions requested by Compliance Director, Compliance Committee, and/or executive leadership.
Documents corrective action plans identified through audits, monitoring departmental performance indicators, or by recommendation of business owner, management or the Board of Directors.
Supports the Compliance Director with the management of State-initiated corrective actions.