Senior Compliance Analyst (Medicare/Medicaid) - Remote

PRIME Therapeutics; United States; Remote; USD 74,000 - 118,000; Full time

Job summary

Prime Therapeutics in the United States is seeking a Senior Compliance Analyst (Medicare/Medicaid) to lead compliance initiatives within assigned areas, support enterprise programs, and partner across the organization to maintain governance and licensing processes.

You will manage sensitive projects, interpret complex requirements, develop executive reporting, and drive effective compliance, with opportunities to influence stakeholders and advance enterprise-wide standards.

Qualifications

• Exceptional written and verbal communication skills.
• Critical thinking and problem-solving for highly complex situations.
• Advanced organization and analytical skills with multitasking ability.
• Ability to present complex information and influence stakeholders at all levels.
• Comprehensive understanding of effective compliance program principles, practices, standards, industry challenges, and emerging approaches.

Responsibilities

• Execute compliance procedures and enforce policy governance to validate regulatory reporting and operational requirements are met.
• Serve as a compliance subject matter expert and develop solutions to highly complex issues; enhance supporting documentation.
• Represent Compliance on complex contracts and cross-functional projects and establish effective stakeholder partnerships.
• Lead project management for highly sensitive or complex compliance initiatives.
• Prepare clear and accurate compliance records and executive or governance reporting for senior leaders and committees.
• Execute and enhance compliance programs, training, conflict of interest, policy governance, and cyclical compliance processes.
• Research and interpret laws, guidance, regulatory issues, and filing requirements; document and escalade findings.
• Manage assigned licensing submissions, filings, renewals, reporting, source documentation, procedures, and tools.
• Other duties as assigned.

Skills

Exceptional written and verbal comms

Critical thinking

Organization & multi-tasking

Stakeholder influence

Compliance program knowledge

Education

Bachelor's degree in business/healthcare

HS diploma or GED

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title Senior Compliance Analyst (Medicare/Medicaid) - Remote Job Description

The Senior Compliance Analyst leads compliance initiatives within assigned areas and supports implementation of enterprise compliance programs. This role manages sensitive projects, serves as a subject matter expert, interprets complex requirements, develops executive reporting, and partners across the organization to maintain effective compliance, governance, and licensing processes.

Responsibilities

• Execute compliance procedures and enforce policy governance to validate regulatory reporting and operational requirements are met.
• Serve as a compliance subject matter expert and develop solutions to highly complex issues; enhance supporting documentation.
• Represent Compliance on complex contracts and cross-functional projects and establish effective stakeholder partnerships.
• Lead project management for highly sensitive or complex compliance initiatives.
• Prepare clear and accurate compliance records and executive or governance reporting for senior leaders and committees.
• Execute and enhance compliance programs, training, conflict of interest, policy governance, and cyclical compliance processes.
• Research and interpret laws, guidance, regulatory issues, and filing requirements; document and escalade findings.
• Manage assigned licensing submissions, filings, renewals, reporting, source documentation, procedures, and tools.
• Other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required 5 years of progressive work experience in legal or compliance related roles for a healthcare or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid, and the Affordable Care Act (ACA).
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

• Exceptional written and verbal communication skills.
• Critical thinking and problem-solving skills for highly complex situations.
• Comprehensive understanding of effective compliance program principles, practices, standards, industry challenges, and emerging approaches.
• Ability to present complex information and influence stakeholders at all organizational levels.
• Advanced organization and analytical skills with ability to manage multiple projects simultaneously.

Preferred Qualifications

• PBM or healthcare experience.
• Certified Compliance and Ethics Professional (CCEP) or Certified in Healthcare Compliance (CHC).
• Project Management Professional (PMP) Medicare Part D, Medicaid, and/or Affordable Care Act experience.
• Advanced degree in a related area of study, such as Juris Doctor Licensing application maintenance, tracking, renewal, and submission experience.

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.

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

Prime Therapeutics LLCis proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

At Prime Therapeutics (Prime), we are a different kind of PBM. We’re reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference. We know that people make all the difference.