Compliance Specialist

Blue Cross of Idaho • Meridian, ID

13d • Onsite

About The Position

The Compliance Specialist II is responsible for supporting the organization’s compliance program with a primary focus on specialty pharmacy and patient care regulatory oversight. This role partners with business owners to help ensure adherence to federal and state regulatory requirements, payer contractual obligations, and government required accreditation standards specific to specialty pharmacy services. The Specialist performs regulatory analysis, auditing, monitoring, risk assessments, issue resolution, policy/procedure assistance and compliance education while serving as a subject matter expert for specialty pharmacy-related compliance requirements.

Requirements

• 4+ years in payer compliance, pharmacy, or clinical operations.
• Bachelor’s degree or equivalent work experience.

Nice To Haves

• Experience with Medicare Part D or pharmacy accreditation preferred.
• Leadership experience preferred.
• Certification in healthcare compliance or Pharmacy Tech certification preferred.
• Licensure as a RN preferred.

Responsibilities

• Analyze and interpret federal and state pharmacy regulations including but not limited to: CMS, FDA, State Boards of Pharmacy, and DOI.
• Provide consultative assistance related to implementation for operations.
• Maintain awareness of REMS programs and specialty drug compliance requirements.
• Coordinate compliance risk assessments for specialty pharmacy functions.
• Support monitoring and auditing work plans.
• Partner with business owners to ensure regulatory requirements are integrated into policies and procedures.
• Coordinate compliance efforts with Pharmacist in Charge.
• Conduct, coordinate and/or review audits of dispensing, documentation, and patient outreach.
• Analyze findings and recommend corrective actions.
• Support external audits including CMS and accreditation reviews.
• Investigate compliance issues and perform risk ranking.
• Develop corrective action plans with stakeholders.
• Track remediation efforts through completion.
• Provide information to Corporate Compliance on training including FWA and HIPAA.
• Distribute regulatory updates and communications.
• Work with Pharmacist in Charge to develop training as needed.
• Advise and/or consult with pharmacy operations and leadership.
• Collaborate with PBMs, manufacturers, and vendors.
• Promote compliance best practices.

Benefits

• paid time off
• paid holidays
• community service and self-care days
• medical/dental/vision/pharmacy insurance
• 401(k) matching and non-contributory plan
• life insurance
• short and long term disability
• education reimbursement
• employee assistance plan (EAP)
• adoption assistance program
• paid family leave program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree