Compliance Analyst - Pharmacy

Wellmark•Des Moines, IA

6d•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 support regulatory compliance. The analyst responds to and assists with regulatory and group audit requests, researches and tracks compliance inquiries, collects internal and external data, and coordinates with peers and partners to resolve identified compliance issues. The role calls for sound judgment when interpreting regulatory guidance and assessing its business impacts, strong organization and project management, and effective collaboration and initiative. Pharmacy or health insurance compliance or risk experience is a plus. The position works on a hybrid schedule, with at least three days (Tuesday, Wednesday, and Thursday) in Wellmark’s Des Moines office and 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, including recognizing inconsistencies, researching issues, and reaching conclusions, with careful attention to detail.
Ability to learn and stay current on compliance best practices and industry regulations related to pharmacy.
Strong verbal and written communication skills, including developing written communications and presenting to internal and external audiences.
Strong documentation skills.
Ability to adapt and manage multiple priorities in a fast-paced environment through effective time management and organization.
Proficiency with Microsoft Office, including Outlook, Excel, and Word.
Technical aptitude to learn new systems quickly.

Nice To Haves

Pharmacy-related compliance 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, CMS audit documentation, review of audit findings, and 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 recommending responses to findings.
Serve as the pharmacy HEDIS expert, 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 applicable legal, regulatory, and ethical business practice requirements while encouraging innovation.
Attend pharmacy team meetings and provide updates on current compliance issues and projects.
Collaborate with 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.