Government Compliance & Risk Analyst

Job Brief

This position is remote eligible

PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help customers, doctors and patients use effective medication therapy to improve health and wellness. For more than 15 years, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees; more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians, and in the services we provide.

PerformRx is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies.

Summary:

The Risk Analyst will assist the Manager, Oversight & Risk Management in ensuring the audit and oversight of internal operations and downstream entities’ compliance with state and federal regulations, to include auditing and monitoring of the business units, and monitoring of First Tier, Downstream and Related Entities (FDRs) and subcontractor-vendors to ensure effective ongoing regulatory compliance. The incumbent will assist the Manager in the oversight of the issuance of Corrective Action Plans (CAPs) when issues of non-compliance are identified and ensures effective tracking of audit outcomes and CAPs. The incumbent will assist in the oversight of Client Audit activities within the organization, and will work with the organization on the identification of organizational risk and annual development of the Risk Assessment. The Analyst’s primary responsibility is to serve with the Manager in the compliance oversight of the compliance of internal operations and downstream entities’ with state and federal regulations through monitoring of metrics based on regulatory guidance and service level agreements. Additionally, the Analyst receives and coordinates internally all responses to client audit notices. The Analyst will prepare periodic reports to senior management, which includes communication of the results of audit and oversight activities to ensure effective ongoing regulatory compliance.

Responsibilities:

• Monitor metrics on a monthly basis and work with business units to improve compliance metric performance to include issuance of Corrective Action Plans if indicated
• Manage site visit preparation process and coordinate annual audits of FDRs; coordinate client audit requests; review results of audits and work with clients and internal departments/FDRs to develop and implement corrective actions
• Maintain a thorough and comprehensive understanding of plan business practices to effectively assess the impact of regulatory requirements
• Participate in the development and implementation of compliance metrics for relevant business units
• Represent compliance area on ad hoc teams as needed
• Oversee development and implementation of and monitor adherence to corrective action plans
• Work with the Compliance Officer and Compliance Committee to coordinate the Risk Assessment process

Education/Experience:

• Minimum two (2) years’ experience working in or with a Pharmacy Benefits Manager (PBM) preferred
• Regulatory and operational compliance and audit experience highly preferred
• Strong communication (listening, verbal, written) and presentation skills
• Extensive knowledge of federal and state regulations required
• Bachelor’s Degree in Business or equivalent field required; equivalent combination of experience and education will be considered
• Minimum five (5) years' experience with managed care, Medicare and/or Medicaid programs required
• Experience in a pharmacy and/or Pharmacy Benefits Manager (PBM) environment helpful
• Strong PC skills including experience with MS Project, MS Office, MS Outlook, or equivalent
• Demonstrate personal traits of a high level of integrity, professionalism, and trustworthiness
• Minimum two (2) years’ experience in a private and/or public sector regulatory agency compliance position required
• Places a high value on ethical standards and treating others with dignity and respect
• Ability to exercise professional judgment in analyzing and resolving issues