Experience Inc. Jobs

Compliance & Privacy Analyst(Hybrid)

Location: Philadelphia, PA

Primary Job Function: Compliance

ID**: 25356

Job Brief

Assists with the implementation, maintenance and monitoring of the Plan Compliance and Privacy Program for the physical health managed care business.

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 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 .

Responsibilities:

Assists with the implementation, maintenance and monitoring of the Plan Compliance and Privacy Program for the physical health managed care and LTSS business. Establishes and maintains a mechanism to monitor, track, respond to and report on Compliance requests/issues. Coordinates and communicates with various internal and external departments. Investigates and resolves compliance and privacy issues. Makes recommendations and develops solutions to areas of risks and implements processes with stakeholders. Supports the Leader of the Plan Compliance and Privacy with reviewing, analyzing and summarizing trends in Medicaid Policy and develops written summaries of their findings. Conducts research of contracts and regulations to support the Compliance and Privacy Program. Also, provide assistance with other compliance and privacy activities identified in the annual Compliance and Privacy Work Plan, including fraud waste and abuse (FWA) activities.

Education/ Experience:

• Bachelor’s Degree.

• 1 to 3 years in healthcare insurance, preferably in a Managed Care environment to include familiarity with compliance and privacy programs, HIPAA and Privacy Laws related to government programs and contracts.

• CHC and/or CHPC certifications preferred

Other Skills:

• Excellent verbal and written communication skills. Familiarity with Facets, including Claims processing.

• Experience in a similar regulatory environment preferred.

EOE Minorities/Females/Protected Veterans/Disabled