Independent Health is a Western New York health insurance organization and one of the region’s earliest Health Maintenance Organizations (HMOs). It provides coverage and related services to approximately 355,000 people through more than 100 plans, products, and services. Its work includes commercial health insurance, pharmacy benefits, Medicare Advantage, and self-funded health plans. The company describes its culture as focused on helping members and employees bring out their best.
Compliance Specialist, Pharmacy Regulations
Support a specialty pharmacy management company’s compliance with regulatory, contractual, privacy and licensing obligations. Research pharmacy rules and coordinate audits, enrollment, renewals, policies and training.
Description
- Administer and monitor contractual and pharmacy regulatory compliance programs.
- Coordinate contract and regulatory work across Reliance Rx teams, the parent Compliance Department, vendors and regulators.
- Research and assess proposed, pending and current laws and regulations affecting pharmacy operations.
- Advise leaders and work with pharmacy, business development and internal audit teams on regulatory and contractual compliance.
- Monitor federal and state requirements covering pharmacy operations, specialty pharmacy, distribution, 340B, Medicare, Medicaid and HIPAA.
- Track regulatory changes and coordinate implementation of applicable requirements.
- Maintain processes for monitoring contractual and regulatory compliance.
- Contribute to contract review, negotiation, implementation and administration.
- Coordinate contract processing, document management, approvals, signatures and record retention.
- Assist with Medicare and Medicaid enrollment across U.S. states and territories.
- Coordinate pharmacy license renewals, PDMP waivers or zero reporting, licensing and credentialing updates, NCPDP profile renewals and payer credentialing.
- Maintain compliance, privacy and security programs, policies, procedures, metrics, dashboards and tracking tools.
- Coordinate compliance training, onboarding, education, attestations, assessments and awareness activities.
- Support committee work, issue escalation, investigations, corrective action plans and regulatory inquiries.
- Assist with privacy and security monitoring, incident reporting, remediation, audits and government investigations.
- Respond to associate questions about compliance, privacy, security and conflicts of interest.
- Work with operations, data management and internal audit on system access, controls and oversight.
Requirements
- An associate degree is required; two additional years of experience may substitute for the degree.
- At least three years of experience in compliance, quality assurance or auditing, or program or process management.
- Healthcare experience is preferred.
- Specialty pharmacy or pharmacy experience is preferred.
- Experience with payer and regulatory enrollment and maintenance is preferred.
- Advanced computer and Windows skills are required.
- Experience with Microsoft Office and the ability to learn new software applications.
- Strong research, analytical, writing, drafting, communication, interpersonal, organizational and project management skills, with sound independent judgment.
- Ability to analyze legislation and develop policies and procedures based on regulatory requirements.
- Ability to build and maintain relationships with internal and external stakeholders.
- Knowledge of compliance principles, particularly HIPAA.
- Initiative, creativity and organizational ability.
- Demonstrated examples of Reliance values: Collaborative, Accessible, Results-Oriented, Empowering and Supportive.
- Immigration or work visa sponsorship is not available.
Benefits
- Eligible for scorecard incentives.
- Full range of benefits.
- Generous paid time off.
- Hybrid work arrangement.