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Job Details

Sr. Healthcare Systems Compliance Analyst

Arlington, VA

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Job Summary
The Senior Healthcare Systems Compliance Analyst
will focus on compliance checking and issue resolution of
(pharmacy benefit manager) participants on the **MEMBERS ONLY**SIGN UP NOW***. network. The incumbent will be the point of contact for **MEMBERS ONLY**SIGN UP NOW***. internal teams for escalated issues related to participant compliance. The incumbent will document compliance processes and procedures, manage compliance testing, provide training and facilitate measurement and process improvement. The incumbent also will conduct compliance checks of prescriber, PBM and pharmacy participants, manage vendor outreach initiatives and build relationships with vendors.
Validate participants are in compliance with **MEMBERS ONLY**SIGN UP NOW***. certification requirements & Network Operations Guide and follow up with out of compliance participants until issues are completely resolved for network optimization of transactions
Develop and test compliance reports, compliance check test plan/test data and execute compliance checks to enhance network transaction quality
Serve as point of contact for cases escalated to compliance department and, when applicable, draft Out of Compliance notifications to be sent to participants
Develop dashboards and metrics and perform ongoing measurement and analysis of team initiatives and successes
Develop and deliver training for new members and perform policy & procedure updates for overall process improvement and documentation
Basic Requirements:
Bachelor degree or equivalent experience
5 years of related experience in health care Information Technology with focus on software implementation or certification
5 years of experience with network connectivity related to transactional and file processing
Preferred Qualifications:
Working knowledge of ANSI X12, 270/271
Experience with XML
Software audit experience
Certification or User Acceptance testing tool experience
Proficiency with MS Word, Excel, and Visio
Background in project management or production support
Experience with process and procedure documentation and reporting
Equal Employment Opportunity/Affirmative Action Employer - Disabled/Vets

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