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- Assist with tracking, reviewing and analyzing regulatory requirements, including new statutes and regulations and impacting the various markets to ensure compliant implementation of the newly passed regulation.
- Assists and supports MRx Compliance with regulatory change review and works with business areas to ensure regulatory changes have been applied correctly.
Assists with the implementation of the Magellan Rx Compliance Program, and Program Integrity Plan. Provides audit, monitoring, training, and investigation support for the oversight of regulatory and contract compliance activities for the Pharmacy Benefit Manager (PBM) and all functional areas and markets managed by Magellan Rx Management, including regulations issued by the Centers for Medicare and Medicaid Services (CMS), and other state and federal regulations.
- Pursues and maintains solid working knowledge of regulations, including regulations issued by the Centers for Medicare and Medicaid Services (CMS), and other federal and state regulations.
- Assists in monitoring activities as directed.
- Supports the production of data and materials in relation to external audits and reviews.
- Assists with the MRx Compliance Department’s administrative duties (e.g., organize relevant files, prepare reports, etc.).
- Assists and supports MRx Compliance with regulatory change review and works with business areas to ensure regulatory changes have been applied correctly.
- Assists in the development of internal compliance monitoring metrics and enters data in Compliance 360 or other GRC systems.
- Works collaboratively to implement controls to enhance the efficiency and effectiveness of the MRx Compliance Program.
- Collects information and assists with investigations.
- Assists with the functional management of the implementation of controls and processes as an effort to prevent, detect, and correct potential compliance and fraud, waste and abuse.
- Coordinates with the MRx Compliance leadership regarding inquiries, potential compliance issues/risks and flags for review with potential violations of internal/external regulatory requirements.
- Assists with Compliance and Fraud, Waste and Abuse training and collaborates with operational areas to ensure that a specialized training process is in place and effective.
Other Job Requirements
Responsibilities
1-3 years of Compliance related experience.
Experience in a health care environment.
Knowledge of Managed Care regulations.
Strong interpersonal, organizational, and project management skills.
Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
Solid analytical and creative problem-solving skills.
Experience and solid understanding of MS Office applications, word processing, flow charting, presentation creation, archiving and other relevant software systems and applications.
General Job Information
Title
Compliance Analyst – Remote Opportunity!
Grade
21
Work Experience – Required
Compliance, Healthcare
Work Experience – Preferred
Education – Required
Associates
Education – Preferred
Bachelors
License and Certifications – Required
License and Certifications – Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
