Role Overview 

This position sits within the Compliance Department.  It will have a focus on communication, engagement and strategy.   Heavy SharePoint usage and involvement with the budget and financial analysis for the department. 

Work Arrangement

This position is a hybrid position located in our Newtown Square Corporate office.   Will be required to be in the office 3 days a week.   

Responsibilities:

Communications and Engagement

• Responsible for monitoring compliance communication tools and timely responses to inquiries and request for technical assistance to promote open lines of communication with associates, contractors, and subcontractor-vendors.
• Demonstrates strong knowledge of Microsoft Office and SharePoint.   Will develop SharePoint content. 

Reporting, Investigating, Monitoring and Auditing

• 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.
• Assist with conducting plan level audits and focused reviews, including but not limited to identifying, gathering and organizing plan level documentation and organizing meetings plan staff. 

• Assist with conducting compliance assessments/reviews to test established and newly executed operational processes and controls.

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, 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 risk assessment development and analysis./regulatory research as needed.
• Monitors and tracks compliance with contractual education and training programs.
• Support budget and financial analysis.  
• Assist and/or leads activities and investigations related to the completion of requirements (e.g., Code of Conduct, Conflict of Interest, etc.,).

Education/Experience:

• Bachelor’s Degree preferred or equivalent experience or education

• Preferred Experience Level (if different from minimum required): at least one to three (1 to 3) years of experience in managed health care including experience in the areas of compliance oversight. 

   

Skills and Abilities:

• 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)
• Self-motivated with demonstrated project management skills, problem solving and critical thinking skills. 
• Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
• Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.
• Acts independently and requires minimal supervision, proactively takes initiative.
• Ability to understand contract and regulatory language, prior experience a plus.

Our Comprehensive Benefits Package

Flexible work solutions including 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’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 Newtown Square, 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.

This position will require an individual with strong clinical understanding.  No license is required, however must understand CMS regulations, health risk assessments and corrective actions for Medicare.   Will need an understanding of the 7 elements of compliance.