Compliance Analyst

Summary

Join SmithRx, a rapidly growing Health-Tech company, as a Compliance Analyst to contribute to a highly-effective compliance program within a dynamic PBM regulatory landscape. You will assist in and lead initiatives to prevent, detect, and correct noncompliance, working closely with Compliance leadership, Legal, and Regulatory Counsel. This remote, full-time position requires strong analytical skills, compliance knowledge, and excellent communication skills. You will develop compliance materials, conduct risk assessments, and investigate non-compliance issues. The ideal candidate possesses a Bachelor’s degree or equivalent experience, at least four years of compliance experience in a relevant field, and preferred certifications. SmithRx offers a comprehensive benefits package including health insurance, retirement plan, paid time off, and professional development opportunities.

Requirements

• Bachelor’s degree or higher education in business or related field, or equivalent years of relevant work experience is required
• Minimum of four (4) years of compliance experience at a PBM or health plan, health plan and pharmacy operations oversight or similar experience would be considered
• Strong familiarity with the seven elements of a highly effective compliance program
• Strong familiarity with pharmacy operations and healthcare benefits
• Strong familiarity with ERISA governed healthcare benefits and government-funded healthcare programs, such as Healthcare Exchange Marketplace (Affordable Care Act) and Medicare preferred (compliance standards imposed upon Delegated and Downstream Entities (DDEs)/ First Tier, Downstream and Related (FDR) entities)
• Working knowledge of data analytics and ability to produce meaningful insight and solutions with sound business judgement
• Proven knowledge of internal and external audit functions and procedures
• Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement
• Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal Leadership at all levels, internal and external Legal Counsel, Corporate Compliance, State and Federal Regulators
• Advanced organizational, project, and time management skills to prioritize, prepare, and leverage resources and stay on focus
• Ability to work independently and within a team environment

Responsibilities

• Report to Compliance leadership, playing a significant role in the development of the Compliance Program
• Use analytical skills and compliance knowledge to be a thought leader and effectively reduce risks to our organization
• Build and maintain positive and strategic relationships with internal and external stakeholders
• Support the open-door posture for reporting and detecting issues of compliance
• Assist in the development of materials and reporting metrics for leadership and applicable oversight committees
• Support the Compliance Program workplan and risk assessments
• Ensure document retention standards and evidence of compliance activities are maintained across our organization
• Assist in the review, development, and completion of regulatory reporting or filings as needed
• Provide or assist in informal or formal training and education related to regulatory and legal requirements such as policies and procedures, regulatory implementations, and more
• Work with Legal and Compliance leadership to interpret regulations and distribute related guidance to impacted stakeholders through SmithRx’s regulatory change and distribution management program
• Design and perform readiness testing
• Investigate potential or reported issues of non-compliance, state-based complaints, and concerns outlined in regulator inquiries
• Assist in internal and external audit and monitoring activities, analyzing outcomes and ensuring detected issues are referred for remediation
• Analyze data and performance outcomes with relevant business leads and/or delegates to ensure compliance with requirements, escalating issues to Compliance leadership
• Identify, document, and escalate new or increasing risks for the purposes of maintaining accurate risk assessments and subsequent mitigation plans
• Perform root-cause analysis with issues of non-compliance
• Ensure proper engagement and documentation with impacted parties so that mitigation activities are executed accurately and timely so that repeat non-compliance is avoided
• Other duties as assigned

Preferred Qualifications

• Certified in Healthcare Compliance (CHC), Certification in Healthcare Privacy Compliance (CHPC), or Certified Compliance and Ethics Professional (CCEP) preferred
• Current, unrestricted clinical or functional business licensure is a bonus (examples: certified pharmacy technician, paralegal, LPN in state of service, analytics, etc.)
• Familiarity with PBM-related healthcare operations and/or clinical concepts, practices and procedures is preferred, or similar health plan knowledge will be considered
• Direct experience with pharmacy benefits, network, and claims is a bonus

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary Paid Time Off
• 12 Paid Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities