The Compliance Manager works closely with assigned business areas, Legal, and other areas of the business on compliance monitoring, issues of non-compliance, implementing new laws and regulations and managing solutions, and other oversight activities.
Implements and maintains compliance programs, policies, and procedures pertaining to Medicare compliance for assigned business areas
Project management of compliance initiatives
Develops solutions to complex compliance problems referring to precedence and policies
Represents the Compliance Department on complex contracts or projects. Interacts with internal staff on matters that require coordination between departments
Develops solutions to complex compliance and business problems which require a high degree of ingenuity, creativity, and innovation
Develops regulatory monitoring and response strategies to regulatory changes including new laws/regulations
Serves as a consultant to management on major matters pertaining to policies, plans and objectives
Serves as compliance contact for assigned internal business teams and Prime clients, consulting with departments across the enterprise to provide program specific knowledge
Is considered an organization-wide Subject Matter Expert in assigned areas such as Coverage Determinations, Appeals and Grievances (Part D), Organization Determinations (Part C) and Pharmacy Audit.
Assists in Government Programs oversight, monitoring and reporting activities
Manage and oversee corrective action plans (CAPS) and the successful tracking of CAPs in the compliance system
Manage and oversee compliance issue management
May oversee other’s work within the department
Other duties as assigned
Bachelors degree or equivalent work experience
7+ years of relevant work experience in government programs, legal, compliance, or related field
Experience developing new concepts, techniques, and standards using a mix of experience and ingenuity as gained through breadth and depth or industry knowledge
Communicates effectively through both verbal and written communication; interpersonally effective
Demonstrated ability to organize work to focus on the most important items
Works effectively with others in different functions or groups; demonstrated experience promoting collaboration and teamwork
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Prime serves nearly 20 million people. It is co...llectively owned by 14 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.