Compliance Analyst – Corrections

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and/or improve the corrective action process.

• Evaluate and prioritize referrals for corrective actions.

• Initiate corrective actions, which include corrective action plans and warning letters.

• Work together with business stakeholders to conduct root cause analysis.

• Recognize opportunities for prevention, detection, and correction.

• Ensure that business partners complete corrective actions promptly and effectively.

• Identify strategies to reduce organizational risks.

• Develop job aids, playbooks, and other relevant program documentation.

• Establish and maintain positive, strategic relationships with both internal and external stakeholders.

• Promote a culture of compliance and ethics.

• Assist in the development or revision of oversight materials and reporting metrics.

• Create and disseminate written compliance standards where necessary.

• Adhere to the organization’s retention standards and version controls.

• Collaborate on compliance training and educational requirements.

• Investigate potential or reported compliance violations.

• Oversee organizational disciplinary actions and incentives for consistency, accuracy, and timeliness.

• Work with Legal and other stakeholders to interpret relevant regulations.

• Fulfill additional responsibilities as assigned.

• Report directly to the Compliance Director.

⛳️ Requirements

• A Bachelor’s degree or higher in healthcare, compliance, or a related discipline, or equivalent years of relevant work experience is required.

• A minimum of four (4) years of compliance experience in a PBM or health plan setting.

• Experience in pharmacy operations oversight or a similar role is advantageous.

• Direct experience with pharmacy benefits, networks, and claims is a plus.

• CHC, CHPC, or CCEP certification is preferred.

• Current, unrestricted clinical or functional business licensure is an added benefit.

• A strong understanding of the seven elements of an effective compliance program is essential.

• Familiarity with PBM-related healthcare operations and/or clinical concepts, practices, and procedures is preferred; similar knowledge of health plans is also considered.

• A robust working knowledge of compliance program corrective actions within healthcare.

• Understanding of external audit functions and procedures is required.

• Familiarity with ERISA, the Healthcare Exchange Marketplace (Affordable Care Act), Worker’s Compensation, and Medicare is preferred.

• Knowledge of pharmacy operations and healthcare benefits is beneficial.

• Excellent verbal and written communication skills are necessary.

• Advanced organizational, project management, and time management skills are essential.

• Ability to work both independently and as part of a team.

• Proficiency in establishing effective collaboration techniques, including conflict resolution.

• Capability to sit or stand for extended periods.

• Occasional travel or visits to SmithRx offices may be required.

🏝️ Benefits

• Highly competitive wellness benefits, including Medical, Pharmacy, Dental, Vision, Life Insurance, and AD&D Insurance.

• Flexible Spending Benefits.

• 401(k) Retirement Savings Program.

• Short-term and long-term disability coverage.

• Discretionary Paid Time Off.

• 12 Paid Holidays.

• Wellbeing benefits.

• Commuter Benefits.

• Paid Parental Leave benefits.

• Employee Assistance Program (EAP).

• Well-stocked kitchens in office locations.

• Opportunities for professional development and training.

• Potential bonuses, commissions, or equity.

• Time off programs.

• Support for mental health.