Compliance Analyst - Pharmacy

Wellmark, Inc.•Des Moines, IA

4d•Hybrid

About The Position

Are you a healthcare compliance professional seeking a new, exciting opportunity to join a fast-growing department? Wellmark is hiring a Pharmacy Compliance Analyst for our evolving Pharmacy Services team! In this role, you will closely partner with team members in Legal, Regulatory Compliance, Pharmacy Quality Assurance, and the broader Pharmacy department, to ensure regulatory compliance. You will also respond to and assist with requests for regulatory and group audits as needed. You will research, track, and report compliance inquiries; collect internal and external data; and coordinate peers and partners across the organization to drive remediation of identified compliance issues through resolution. Collaboration and building internal partnerships are key to success in this role. You are inquisitive and a natural critical thinker. You have the keen ability to review regulatory guidelines and understand the potential business impact of the changes, addressing both up and downstream impacts. You are highly organized, and you effectively prioritize work to timely complete initiatives. Project management skills are essential. You actively build partnerships across the organization and thrive in a collaborative environment balanced with a role where taking initiative is important. You will have ownership of your work and have a seat at the table for introducing creative recommendations on challenging regulatory needs. Pharmacy and/or health insurance compliance or risk experience is a plus!

Requirements

Bachelor’s degree or direct and equivalent work experience.
4+ years of health insurance, health care, or related industry experience, including reading, understanding, applying and/or communicating established rules, regulations, guidelines, or policies.
Demonstrated analytical skills to recognize inconsistencies, research and come to a conclusion, and careful attention to detail.
Aptitude to learn and stay current on compliance best practices and industry regulations as it relates to pharmacy.
Strong verbal and written communication skills, including but not limited to, developing written communication and presenting to various internal and external audiences. Strong documentation skills.
Flexible, adaptable, and able to effectively manage multiple priorities in a fast-paced environment through effective time management and organization.
Proficiency with Microsoft Office – e.g., Outlook, Excel, Word. Technical aptitude to learn new systems quickly.

Nice To Haves

Pharmacy related compliance experience.

Responsibilities

Manage day-to-day regulatory compliance related to pharmacy, according to established policies and procedures, by facilitating identification of and reporting on the status and resolution of pharmacy compliance issues through effective and timely coordination with leadership, pharmacy staff and Compliance Team members.
Support pharmacy team in oversight of Exchange related tasks including downstream delegated entity (DDE) monitoring, JSON files, gathering documentation for CMS audits, reviewing audit findings and making recommendations to pharmacy team.
Serve as the pharmacy NCQA expert, including gathering evidence for annual submission, review and ensure adherence to related policies & procedures, gather documentation for and participate in audits, review audit findings and make recommendations to pharmacy team.
Serve as the pharmacy HEDIS expert, including reviewing and updating data and materials for annual audit and accreditation.
Gather and submit MCAS data for annual submission to Division of Insurance.
Ensure that pharmacy policies and procedures are reviewed and updated annually, or as requested, for compliance purposes. Develop new policies and procedures, as needed.
Support corporate compliance and business ethics functions, including serving as a Compliance Team Member and Regulatory Compliance Liaison; assist business units in assuring compliance with applicable state and federal laws and regulations, and ethical business practices while encouraging innovation.
Attend pharmacy team meetings to provide the Wellmark pharmacy team updates on current compliance related issues and projects.
Collaborate with the Wellmark Compliance staff to support activities related to ethics and compliance matters related to the Medicare Advantage PDP business.
Participate and consult on pharmacy compliance related meetings or phone calls with the Compliance Office; research and provide data for audits as requested for internal and external audits.
Other duties as assigned.