Regulatory Analyst
Prime Therapeutics · Remote · remote · Posted 48d ago
Undisclosed3–8 yrsfulltimeSourced from
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About this role
Job Summary
Responsibilities
Minimum Qualifications
Additional Qualifications
Preferred Qualifications
Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.
Regulatory Analyst - Remote
The Regulatory Analyst is responsible for leading portions of regulatory assessment, external audits and accreditation processes within the Commercial, Medicare, Medicaid, and Health Insurance Marketplace for the assigned department. This position is responsible for primary point of contact for internal and external business partners regarding related regulatory activity and quality efforts involving utilization and/or medication therapy management, client delegation agreements and accreditation entities, SOP development and maintenance.
Responsibilities
- Participate in portions of external audits as directed by the Centers for Medicare Medicaid Services (CMS), Medicaid, NCQA, participate in commercial and Client driven external audits, annual reviews, and pre-delegation reviews and lead assigned department (i.e. Clinical Operations, PBM Operations) portions of ongoing Accreditation processes
- Assist in Regulatory Review Committee Meetings, Healthcare Reform Meetings, Regulatory Oversight Meetings, CMS User Calls, and Government Programs Compliance Committee Meetings to monitor new regulations and provide necessary updates to these committees
- Lead the Client, external auditor, and/or accreditation reviewer through Prime's business processes and provide the appropriate documentation and/or data files as they relate to accreditation standards or regulations
- Maintain regulatory and accreditation gap status reporting to keep all constituencies informed; track, manage, and report on work stream status against plan
- Lead all efforts for response to inquiries related to the assigned department, which may include pulling pertinent case files/samples, validating regulatory requirements, and review and validation of processes against requirements
- Take lead on change management related to regulatory requirements
- Other duties as assigned
Minimum Qualifications
- Bachelors degree in business, finance, health services or related area of study, or equivalent combination of education and/or relevant work experience
- 3 years of PBM, healthcare, and/or compliance work experience
- Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
- Strong verbal and written communication skills
- Demonstrated critical thinking and analysis skills with the ability to interpret regulations into operational requirements
- Strong attention to detail and commitment to meeting established timeliness
Preferred Qualifications
- Demonstrated knowledge of CMS regulations and Health Care Reform and extensive knowledge of clinical review and/or medication therapy management processes/procedures
- Proficient in standard software (Word, Visio, and Excel)
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.
Sourced from naukri
Skills
CMSVisiotherapyauditsHealth ServicesMedicaidmedicareClinical Operationssecurity controlsChange ManagementSop DevelopmentPharmacyReviewerHealthcareCommunication SkillsoperationsmaintenanceLegalcompliancefinance
About Prime Therapeutics
Prime Therapeutics
Eagan
US
About
Prime Therapeutics is a pharmacy benefit management company that partners with health plans, employers, and government programs to provide cost-effective prescription drug services. It focuses on improving patient outcomes by managing medication access, affordability, and adherence. Through integrated solutions and collaborative care, Prime Therapeutics helps millions of members optimize their pharmacy benefits while reducing overall healthcare costs.
Industries
Health CarePharmaceutical
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