Compliance Associate

Pharmpix • PR

120d

About The Position

The Compliance Associate reports directly to the Compliance Director and plays a key role in ensuring the organization’s adherence to all applicable federal and state regulations, contractual obligations, internal policies, procedures, and standard operating procedures (SOPs) with a particular focus on Medicare-related requirements. The CA supports the development, implementation, monitoring, and oversight of comprehensive compliance programs designed to mitigate risk, uphold regulatory standards, and promote ethical business practices across all operational areas. The Compliance Associate collaborates with various departments to identify potential compliance risks and assists in conducting audits and investigations to address any issues. Ultimately, the Compliance Associate contributes to the organization's mission by ensuring operational compliance and protecting both patients and the organization from legal and regulatory challenges.

Requirements

• Bachelor’s degree in healthcare administration, law, or a paralegal degree.
• 1-3 years of experience in a PBM /Health Plan environment and/or Medicare-related programs.
• 1-2 years of experience working with contractual agreements.
• Fully bilingual English and Spanish.
• Knowledge of CMS regulations and Medicare compliance standards.
• Proficiency in Microsoft Office 365 (Word, PowerPoint, Excel, etc.).
• Computer knowledge.
• Business process understanding.
• Knowledge of producing clear, structured, and accurate documentation, including reports, SOPs, and compliance materials.

Nice To Haves

• Certified Compliance & Ethics Professional (CCEP) preferred.

Responsibilities

• Draft agreements, amendments, and legal documents according to Company directions.
• Track the execution of legal documents.
• Review applicable local, Medicare and state regulations and file any necessary information with regulatory agencies, if appropriate.
• Monitor and interpret regulatory changes impacting PBM operations, including CMS guidelines, HIPAA, and Medicare Part D.
• Assist in maintaining compliance with Medicare regulations, including formulary management, reporting requirements, and audit readiness.
• Conduct periodic internal reviews or audits to ensure that compliance procedures are followed.
• Disseminate written policies and procedures related to compliance activities.
• File appropriate compliance reports with regulatory agencies if applicable.
• Maintain documentation of compliance activities, such as complaints received or investigation outcomes.
• Discuss emerging compliance issues with management or employees.
• Collaborate with other departments to ensure documents are processed and handled in a timely and efficient manner.
• Provide employee training on compliance-related topics, policies, or procedures.
• Assist internal or external auditors in compliance reviews, including URAC, SAE 16, and CMS audits.
• Prepare management reports regarding compliance operations and progress.
• Verify that all firm and regulatory policies and procedures have been documented, implemented, and communicated.
• Direct the development or implementation of compliance-related policies and procedures throughout an organization.
• Review or modify policies or operating guidelines to comply with changes to environmental standards or regulations.
• Perform other duties as assigned by the Compliance Director.

Benefits

• Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans.

What This Job Offers

• Career Level: Entry Level
• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees