Massachusetts Jobs

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Senior Compliance Analyst MRx

Job Description Summary

Assists with the implementation, and supports the management of the Magellan Rx Compliance Program, and Program Integrity Plan. Responsible for regulatory complaint adjudication, 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.

Job Description

• Responsible for investigation and adjudication of regulatory requirements, such as Medicare's Complaint Tracking Module (CTM), Department of Insurance (DOI) complaints, Compliance Hotline (Participation in Compliance Investigations), Attorney General, Civil Rights Hotline, Department of Insurance Complaints, Better Business Bureau Complaints) – Members, providers, clients, and regulatory for MRx all lines of business (LOBs).

• Maintains solid working knowledge of Federal and State managed care regulatory requirements related to assigned care center.

• Participates in the Delegation Audits by preparing Compliance reporting analysis for assigned tasks.

• Participates in the First Tier Downstream and Related Entity (FDR) Delegation oversight process by assisting with support of reviewing documentation for FDR audits and meeting minutes for the FDR Committee.

• Participates in the Training process (SABA) and Workday Assignments Support (Conflict of Interest, CMS Trainings, State and Client Trainings).

• Supports the production of data and materials in relation to audits and reviews.

• Assists in the development of metrics, and monitoring activities as directed.

• Assists and supports MRx Compliance with regulatory change review and works with business areas to ensure regulatory changes have been applied correctly.

• Works collaboratively to implement controls to enhance the efficiency and effectiveness of the MRx Compliance Program.

• 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.

Responsibilities

• 3-5 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.

• Bachelor's degree preferred.

• Managed Care, PBM or other healthcare entity experience preferred.

Work Experience

Work Experience - Required:

Compliance, Healthcare

Work Experience - Preferred:

Education

Education - Required:

A Combination of Education and Work Experience May Be Considered., Associates

Education - Preferred:

Bachelors

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $54,190.00 - $86,690.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.