Compliance Specialist - Senior

Independent Health•Buffalo, NY

7d•$30 - $40

About The Position

The Compliance Specialist-Senior will manage and monitor compliance activities related to PBD’s accreditations, certifications, licenses, and regulatory requirements (e.g., URAC PBM accreditation, Utilization Review licenses). The position will ensure policies, procedures, and reporting align with compliance standards. The Specialist will interpret and advise on accreditation and regulatory requirements and review documentation for audit readiness and compliance. This position will serve as a liaison with accreditation bodies and will coordinate validation reviews. They will also support regulatory audits, market conduct exams, and compliance submissions in addition to facilitating meetings, dashboards, and oversight activities with leadership and committees. This position will manage policy and procedure processes and timelines and coordinate STAR measures, corrective actions, and privacy/security events.

Requirements

High school diploma or GED required.
Four (4) years of compliance, legal, quality monitoring/reporting, or program/process management experience required.
Experience in the creation or review of policies, procedures, and reports and ability to assess controls needed to meet requirements, render decisions and troubleshoot issues.
Excellent analytical and critical thinking skills, with proven ability to analyze abstract components of legislation, regulations, or accreditation standards for requirements identification.
Strong problem solving, time management and organizational skills.
Advanced PC and Microsoft Office applications required.
Excellent presentation, interpersonal, written, and verbal communication skills.
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

Associates degree preferred.
Experience working with regulatory and accreditation agencies (e.g. URAC, DOL and CMS) and compliance, quality monitoring/reporting or program management preferred.

Responsibilities

Review and interpret program standards, regulations and legislation to understand, document and aid in the development and implementation of processes and documentation necessary for accreditation, certification, registration and/or licensing.
Provide subject matter expertise and support to PBD’s associates and leadership team in achieving and maintaining accreditations, certifications, registrations and/or licensure pertaining to Pharmacy Benefit Management.
Organize and run cross-functional and inter-departmental project teams performing necessary preparation activities for accreditation, certification, registration and/or licensing submissions, mid-cycle audits and renewals; including but not limited to coordinating and/or assisting in gathering requested information, updating, and reviewing documentation for accuracy and other activities as deemed necessary.
Facilitate and coordinate periodic reviews and mock audits and maintain documentation and reporting to ensure PBD is audit ready for accreditation renewals.
Assist in establishing new and revising existing documentation, including but not limited to policies and procedures to support accreditations.
Monitor and evaluate programs and operations compliance with accreditation standards and any state and/or federal regulatory requirements as necessary.
Work with VP and Compliance Officer to coordinate and facilitate program requirements, meetings, note taking and dashboard maintenance for the Quality Management Committee.
Facilitate the organizational policy and procedure process to ensure all functional areas are maintaining their documentation per company policies; and facilitate policy committee meetings.
Develop and maintain monitoring dashboards and trend reports for Medicare Part D STAR measures.
Monitor compliance with accreditations, requirements, policies, and procedures to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance.
Coordinate and monitor reporting and progress of remediation efforts for instances of non-compliance, including but not limited to corrective action plans and HIPAA privacy and security events.