Senior Compliance Analyst (Medicare/Medicaid) - Remote
About The Position
The Senior Compliance Analyst leads compliance initiatives within assigned areas and supports implementation of enterprise compliance programs. The role manages sensitive projects, serves as a subject matter expert, interprets complex requirements, develops executive reporting, and partners across the organization to maintain effective compliance, governance, and licensing processes. The position is remote and focuses on Medicare and Medicaid compliance. The employee must understand, comply with, and attest to the security responsibilities and controls unique to the job, as well as applicable legal, regulatory, contractual, and internal requirements. The employee must be able to perform the essential functions of the job; reasonable accommodations will be made when requested, absent undue hardship. Prime may change or assign other duties to the role.
Requirements
- Bachelor’s degree in business, healthcare, or a related area, or an equivalent combination of education and/or relevant work experience; high school diploma from an accredited school or equivalent GED is required.
- Five years of progressive work experience in legal or compliance-related roles for a healthcare or PBM organization, or another 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.
- 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 the ability to manage multiple projects simultaneously.
- Must comply with job-specific security responsibilities and controls, and applicable legal, regulatory, contractual, and internal requirements.
- Must be able to perform the essential functions of the job, with reasonable accommodations available upon request absent undue hardship.
Nice To Haves
- 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.
Responsibilities
- Execute compliance procedures and enforce policy governance to validate regulatory reporting and operational requirements are met.
- Serve as a compliance subject matter expert, develop solutions to highly complex issues, and 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.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
