Compliance Analyst

{
  "content_hash": "172e0a41c88e80f4ee65a68f2e55228d014df9743292b402c9c645d9c2a9fdf0",
  "source_hash": "d381899826fab774ee362875da51bcf29f3c0bbb1373aceaa0b61000dfc1b059",
  "last_changed_at": "2026-06-06T12:10:34.201Z",
  "active_status": "active"
}

{
  "language": "en",
  "location": {
    "raw": "GUAYNABO, PR, US, GUAYNABO, PR",
    "city": "GUAYNABO",
    "region": null,
    "country": "United States",
    "is_remote": false,
    "confidence": 0.95
  },
  "salary_max": null,
  "salary_min": null,
  "inferred_at": "2026-06-06T12:10:34.179Z",
  "launch_scope": {
    "reason": "english_us_canada",
    "included": true,
    "language": "en",
    "location": {
      "raw": "GUAYNABO, PR, US, GUAYNABO, PR",
      "city": "GUAYNABO",
      "region": null,
      "country": "United States",
      "is_remote": false,
      "confidence": 0.95
    },
    "countries": [
      "United States"
    ]
  },
  "remote_policy": null,
  "salary_period": null,
  "workplace_type": "on_site",
  "salary_currency": null
}

{}

{
  "detail": {
    "links": [],
    "itemID": "9201960944618_1",
    "postDate": "2026-05-27T14:11:00.000-04:00",
    "workLevelCode": {
      "shortName": "Full Time"
    },
    "customFieldGroup": {
      "dateFields": [
        {
          "nameCode": {
            "codeValue": "PostingDate"
          },
          "dateValue": "2026-05-27T14:11Z"
        },
        {
          "nameCode": {
            "codeValue": "CurrentServerDateTime"
          },
          "dateValue": "2026-06-06T08:10Z"
        }
      ],
      "numberFields": [
        {
          "numberValue": 0,
          "categoryCode": {
            "codeValue": "ApplicantCount"
          }
        },
        {
          "categoryCode": {
            "codeValue": "AwardAmount"
          }
        }
      ],
      "stringFields": [
        {
          "nameCode": {
            "codeValue": "ExternalJobID"
          },
          "stringValue": "576015"
        },
        {
          "nameCode": {
            "codeValue": "CareerCenterRefId"
          }
        },
        {
          "nameCode": {
            "codeValue": "GuidelineOid"
          }
        },
        {
          "nameCode": {
            "codeValue": "CurrencySymbolOrCode"
          }
        },
        {
          "nameCode": {
            "codeValue": "HomeDepartment"
          },
          "stringValue": ""
        },
        {
          "nameCode": {
            "codeValue": "JobClass"
          }
        }
      ],
      "indicatorFields": [
        {
          "nameCode": {
            "codeValue": "PriortyStatusFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "InternalPostingFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "MinValue"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsVsidApplicable"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForExtPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForIntPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsMonetaryFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsNonMonetaryFlag"
          },
          "indicatorValue": false
        }
      ]
    },
    "requisitionTitle": "Compliance Analyst",
    "clientRequisitionID": "2107",
    "organizationalUnits": [],
    "postingInstructions": [],
    "additionalProperties": {},
    "requisitionLocations": [
      {
        "address": {
          "cityName": "GUAYNABO",
          "postalCode": "00968",
          "countrySubdivisionLevel1": {
            "codeValue": "PR"
          }
        },
        "nameCode": {
          "shortName": " GUAYNABO, PR, US"
        },
        "aliasNames": []
      }
    ],
    "screeningRequirements": [],
    "requisitionDescription": "<div><p data-pasted=\"true\">JOB SUMMARY &amp; RESPONSIBILITIES</p><p>The Compliance Analyst is responsible for supporting the organization&rsquo;s compliance program through monitoring, analysis, investigations, and risk identification activities. This role focuses on ensuring adherence to applicable laws, regulations, internal policies, and contractual requirements, while promoting a culture of integrity, accountability, and continuous improvement. The Compliance Analyst works cross-functionally to identify compliance risks, support mitigation strategies, and enhance the effectiveness of the Quality &amp; Compliance Program.</p><p>Responsibilities include, but are not limited to:</p><p>Compliance Monitoring &amp; Oversight</p><ol><li>Review operational processes and related documentation and controls of pharmacy records and associated claims applying expertise in coding guidelines, medical policies, and payment procedures.</li><li>Conduct desktop reviews, on-site audits and monitoring activities of the pharmacy network and third-party vendors to ensure the appropriateness of billing practices and compliance with regulatory requirements.</li><li>Perform contract reviews to evaluate and ensure compliance with all applicable laws, regulations, and specific contractual obligations.</li><li>Collaborate in the administration of the exclusion list screening process (e.g., OIG, GSA, and other regulatory bodies)</li><li>Data Analysis &amp; Risk Identification</li><li>Collect, analyze, and interpret data to identify trends, anomalies, and potential compliance risks</li><li>Support the development of reports, dashboards, and metrics to monitor compliance performance</li><li>Review pharmacy records, claims, prescriptions, employee documentation, contracts, licenses, and other relevant billing-related information to identify potential risks, compliance gaps, and operational improvement opportunities.</li></ol><p>Investigations &amp; Issue Resolution</p><ol><li>Conduct or support investigations related to compliance concerns, including Fraud, Waste, and Abuse (FWA), complaints, inquiries and Social Determinants of Health (SDOH) cases</li><li>Triage and channel findings from investigations to the appropriate departments for resolution or intervention</li><li>Document findings and provide recommendations for corrective actions</li><li>Risk Mitigation &amp; Continuous Improvement</li><li>Assist in the development and implementation of corrective action plans (CAPA)</li><li>Monitor effectiveness of corrective actions and identify opportunities for process improvement</li><li>Identify and document the root cause that led to the identified error to design the corresponding action plan</li></ol><p>Regulatory &amp; Quality Support</p><ol><li>Support regulatory readiness and compliance with accreditation standards (e.g., URAC, ACHC, Joint Commission)</li><li>Assist with audits, surveys, complaints management and regulatory requests (e.g., RFIs)</li><li>Ensure adHerence to state and federal laws and regulations, internal policies, and contract requirements.</li><li>Supports all functions related to Q&amp;C Department internal/external reporting activities.</li><li>Collects, prepares, reviews, and submits requested information, data, and documents to Executive Management Staff.</li><li>Collaborate with the Q&amp;C team, as needed to meet department goals, and perform other duties as assigned.</li><li>Supports the Quality and Compliance Leadership in the administration of the Quality &amp; Compliance Program and objectives.</li><li>Actively supports Alivia Health Core Values and Mission through professional behavior and daily job performance.</li><li>May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.</li></ol><p>Policies, Procedures &amp; Documentation</p><ol><li>Support the development, review, and maintenance of compliance-related policies and procedures</li><li>Ensure proper documentation and recordkeeping of compliance activities</li><li>Cross-Functional Collaboration</li><li>Collaborate with business units to address compliance risks and improve processes</li><li>Provide guidance and support to operational teams on compliance-related matters</li><li>Analyze and review confidential and highly sensitive investigative material/documents concerning insured, prescribers, or employees.</li><li>Detect and correct potential errors that may result in potential recovery to the company.</li><li>Give recommendations to the management team for possible solutions or improvement.</li></ol><p>Training &amp; Awareness</p><ol><li>Support compliance training and education initiatives</li><li>Promote awareness of compliance requirements and ethical standards</li><li>Develop and deliver training programs and awareness material, serving as the primary resource for compliance education and ongoing staff development.</li></ol><p>Reporting</p><ol><li>Prepare and present compliance reports, findings, and recommendations to leadership</li><li>Escalate significant compliance risks or issues as appropriate</li><li>Prepare and submit required fraud, waste, and abuse &ldquo;FWA&rdquo; reports to the management team, payors and/or regulatory agencies.</li><li>Support in the regulatory agencies&#39; request for information &ldquo;RFI&rdquo; received.</li><li>Work with business units&rsquo; heads and staff to identify monitoring areas; collect, analyze, and interpret data and report results of monitoring initiatives.</li></ol><p data-pasted=\"true\">Experience:</p><ol><li>A minimum of three (3) years&rsquo; of experience in pharmacy field and performing audits in billing and coding, pharmacy records review, clinical information extraction, medical terminology, and risk identification in operational areas.</li><li>Education, Certifications &amp; Licenses:</li><li>Bachelor&rsquo;s degree in business administration, Healthcare Administration, Health Sciences, or related field required.</li><li>Pharmacy Technician associate&rsquo;s degree.</li><li>Certifications / Licenses: Certification in billing and coding, such as Certified Coding Associate (CCA), or Certified Coding Specialist (CCS), or Certified Risk Adjustment Coder (CRC), or Certification in Medical Billing, or ICD-10-CM are preferred.</li></ol><p>Skills:</p><ol><li>Ethical leadership skills and able to lead by the values of the organization.</li><li>Demonstrated emotional intelligence and diplomacy when engaging with others.</li><li>Demonstrated advanced verbal and written communication skills.</li><li>Ability to keep sensitive information confidential.</li><li>Possess a facilitating mindset to build strong customer connectivity.</li></ol><p>Project management skills.</p><ol><li>Demonstrated problem solving skills.</li><li>The ability to work independently and as part of a team.</li><li>Ability to maintain objectivity and lack bias in evaluations.</li><li>Critical thinking ability (analytical) with excellent organizational skills.</li><li>Detail oriented.</li></ol><p>Technical Skills:</p><ol><li>Knowledge of Microsoft Office programs (Word, Excel, Power Point) is required.</li><li>Basic knowledge in data analysis technique.</li></ol><p>Languages:</p><ol><li>Fully bilingual in English and Spanish (Written and Verbal) REQUIRED EDUCATION, TRAINING &amp; LICENSURE/CERTIFICATIONS</li><li>For Pharmacy Technician it is required to have a license and registration.</li><li>For other related health Since related field will depend on the specialty and requirements by applicable health boards.</li></ol><p>PHYSICAL REQUIREMENTS</p><ol><li>Must be able to remain in seated position for a large part of the workday.</li><li>The person in this position needs to occasionally move about inside the office to access other employees, file cabinets, office machinery, etc.</li><li>An employee must be able to talk, hear, and see, and must be able to grasp and reach objects.</li><li>Visual acuity is necessary to read and write handwritten and typewritten materials and view a computer terminal.</li><li>Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer). Use of hands (specifically fingers) is necessary for appropriate and efficient computer use.</li><li>Must be able to lift a minimum ten (10) pounds.</li><li>Valid driver&rsquo;s license: safe driving record with the ability to drive during the day and nighttime.</li></ol><p>***EEOC F/M/V/D***</p></div>\n",
    "sponsoredVisaTypeCodes": []
  },
  "list_job": {
    "links": [],
    "itemID": "9201960944618_1",
    "postDate": "2026-05-27T14:11:00.000-04:00",
    "workLevelCode": {
      "shortName": "Full Time"
    },
    "customFieldGroup": {
      "dateFields": [
        {
          "nameCode": {
            "codeValue": "PostingDate"
          },
          "dateValue": "2026-05-27T14:11Z"
        },
        {
          "nameCode": {
            "codeValue": "CurrentServerDateTime"
          },
          "dateValue": "2026-06-06T08:10Z"
        }
      ],
      "numberFields": [
        {
          "numberValue": 0,
          "categoryCode": {
            "codeValue": "ApplicantCount"
          }
        },
        {
          "categoryCode": {
            "codeValue": "AwardAmount"
          }
        }
      ],
      "stringFields": [
        {
          "nameCode": {
            "codeValue": "ExternalJobID"
          },
          "stringValue": "576015"
        },
        {
          "nameCode": {
            "codeValue": "CareerCenterRefId"
          }
        },
        {
          "nameCode": {
            "codeValue": "GuidelineOid"
          }
        },
        {
          "nameCode": {
            "codeValue": "CurrencySymbolOrCode"
          }
        },
        {
          "nameCode": {
            "codeValue": "HomeDepartment"
          },
          "stringValue": ""
        },
        {
          "nameCode": {
            "codeValue": "JobClass"
          }
        }
      ],
      "indicatorFields": [
        {
          "nameCode": {
            "codeValue": "PriortyStatusFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "InternalPostingFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "MinValue"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsVsidApplicable"
          },
          "indicatorValue": true
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForExtPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsSassDlReqForIntPostFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsMonetaryFlag"
          },
          "indicatorValue": false
        },
        {
          "nameCode": {
            "codeValue": "IsNonMonetaryFlag"
          },
          "indicatorValue": false
        }
      ]
    },
    "requisitionTitle": "Compliance Analyst",
    "clientRequisitionID": "2107",
    "organizationalUnits": [],
    "postingInstructions": [],
    "additionalProperties": {},
    "requisitionLocations": [
      {
        "address": {
          "cityName": "GUAYNABO",
          "postalCode": "00968",
          "countrySubdivisionLevel1": {
            "codeValue": "PR"
          }
        },
        "nameCode": {
          "shortName": " GUAYNABO, PR, US"
        },
        "aliasNames": []
      }
    ],
    "screeningRequirements": [],
    "sponsoredVisaTypeCodes": []
  },
  "detail_meta": {
    "url": "https://workforcenow.adp.com/mascsr/default/careercenter/public/events/staffing/v1/job-requisitions/576015?cid=aa4140e0-00da-418b-a0e8-527c6d568909&ccId=19000101_000001&lang=en_US&locale=en_US",
    "http_status": 200,
    "content_type": "application/json;charset=UTF-8",
    "response_bytes": 12381
  },
  "detail_errors": []
}