Compliance Specialist - Medicare

AmeriHealth Caritas

Philadelphia, PA 19133

Posted 1 month ago

Job Description

**Compliance Specialist - Medicare**


Location: Philadelphia, PA


Primary Job Function: Compliance


ID**: 24201


**Job Brief**


This role is remote.


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 Specialist position is responsible for compliance program activities related to federal and state regulations and industry standards. This includes tracking, reviewing and analyzing Medicare policies, regulations and compliance requirements that could impact PerformRx's Medicare Advantages and Part D products; responding to internal requests for regulatory interpretation and guidance on Medicare Advantage and Part D; and implementing the annual Medicare Advantage and Part D Compliance program. The incumbent will serve as a subject matter expert within the Company regarding Medicare Advantage and Part D compliance issues and will work with individual departments to research, identify and address areas of vulnerability related to Compliance and prepare a work plan that describes the activities to control against the identified risks. This individual is also responsible for implementing processes to ensure regulatory compliance, including performing monitoring activities and validating departmental audits. The position provides support and coordination of activities for the PerformRx CIQA Compliance Manager.


**Education/ Experience:**


+ Bachelor’s Degree or relevant experience.


+ Minimum of two (2) years healthcare industry, pharmacy benefit management, or health plan experience.


**Other Skills:**


+ Previous compliance experience preferred or related field.


EOE Minorities/Females/Protected Veterans/Disabled



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