Compliance Analyst - Pharmacy

Wellmark, Inc.•Des Moines, IA

8d•Hybrid

About The Position

Wellmark is hiring a Pharmacy Compliance Analyst for its Pharmacy Services team. The role partners with Legal, Regulatory Compliance, Pharmacy Quality Assurance, and the broader Pharmacy department to ensure regulatory compliance. The analyst responds to and assists with regulatory and group audit requests, researches, tracks, and reports compliance inquiries, collects internal and external data, and coordinates with colleagues and partners to remediate identified compliance issues through resolution. Collaboration, internal partnership-building, initiative, and project management are important to success. The position manages day-to-day pharmacy regulatory compliance and supports compliance activities related to Exchange tasks, CMS audits, NCQA, HEDIS, MCAS submissions, pharmacy policies and procedures, corporate compliance, business ethics, and Medicare Advantage PDP matters. It also participates in pharmacy compliance discussions and provides updates on compliance issues and projects. This is a hybrid role requiring at least three days per week (Tuesday, Wednesday, and Thursday) in Wellmark's Des Moines office, with the option to work remotely on Monday and Friday.

Requirements

Bachelor’s degree or direct and equivalent work experience.
At least 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 issues, reach conclusions, and attend carefully to detail.
Ability to learn and stay current on compliance best practices and industry regulations relating to pharmacy.
Strong verbal and written communication skills, including developing written communications and presenting to internal and external audiences; strong documentation skills.
Flexibility and adaptability, with the ability to manage multiple priorities in a fast-paced environment through effective time management and organization.
Proficiency with Microsoft Office, such as Outlook, Excel, and Word.
Technical aptitude to learn new systems quickly.
Inquisitiveness, critical-thinking ability, organization, prioritization, project management skills, initiative, and ability to build partnerships and work collaboratively are described as important to success.

Nice To Haves

Pharmacy-related compliance experience.
Pharmacy and/or health insurance compliance or risk experience.
Proficiency in HROR.

Responsibilities

Manage day-to-day pharmacy regulatory compliance according to established policies and procedures, coordinating the identification, reporting, and resolution of compliance issues with leadership, pharmacy staff, and Compliance Team members.
Support oversight of Exchange-related tasks, including downstream delegated entity monitoring, JSON files, collecting documentation for CMS audits, reviewing audit findings, and making recommendations to the pharmacy team.
Serve as the pharmacy NCQA expert by gathering evidence for annual submission, reviewing adherence to related policies and procedures, gathering audit documentation, participating in audits, and making recommendations based on findings.
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 the Division of Insurance.
Ensure pharmacy policies and procedures are reviewed and updated annually or as requested, and develop new policies and procedures as needed.
Support corporate compliance and business ethics functions as a Compliance Team Member and Regulatory Compliance Liaison, assisting business units with compliance with applicable state and federal laws and regulations and ethical business practices.
Attend pharmacy team meetings and provide updates on current compliance issues and projects.
Collaborate with Wellmark Compliance staff on ethics and compliance matters related to the Medicare Advantage PDP business.
Participate in and consult on pharmacy compliance meetings or calls with the Compliance Office, and research and provide data for internal and external audits as requested.
Perform other duties as assigned.