What are the responsibilities and job description for the Compliance Analyst - Pharmacy position at Wellmark Blue Cross and Blue Shield?
Company Description
Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
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Job Description
Use Your Strengths at Wellmark as a Compliance Analyst for Pharmacy!
About the opportunity : Are you a healthcare compliance professional seeking a new, exciting opportunity to join a fast-growing team? Wellmark is looking to add a Pharmacy Compliance Analyst to our evolving Pharmacy Services team! In this key role, you will work in partnership with our Legal / Compliance teams, and the Quality Program & Accreditation team, to ensure compliance across the Pharmacy department. You will respond to and assist with requests for regulatory audits. You will research, track, report and resolve inquiries, plus collect internal and external data on compliance needs to further address and find resolutions.
About you : You are inquisitive and a natural critical thinker. You have the keen ability to review regulatory guidelines and understand the potential business impact of the changes. You are incredibly organized, and you effectively prioritize work to complete initiatives timely. You actively build partnerships across the organization and thrive in a collaborative environment balanced with a role where taking initiative is important.
Pharmacy and / or health insurance compliance or risk experience is a plus!
This position will work a hybrid schedule of at least 3 days in Wellmark's Des Moines office, with 2 days remote option.
Qualifications
Preferred Qualifications - Nice to have :
- Pharmacy related compliance experience.
Required Qualifications - Must have :
Additional Information
What you will do as a Compliance Analyst for Pharmacy :
a. Manage day-to-day regulatory compliance related to pharmacy, according to established policies and procedures, by facilitating identification of and reporting on the status and resolution of pharmacy compliance issues through effective and timely coordination with leadership, pharmacy staff and Compliance Team members.
b. Support pharmacy team in oversight of Exchange related tasks including downstream delegated entity (DDE) monitoring, JSON files, gathering documentation for CMS audits, reviewing audit findings and making recommendations to pharmacy team.
c. Serve as the pharmacy NCQA expert, including gathering evidence for annual submission, review and ensure adherence to related policies & procedures, gather documentation for and participate in audits, review audit findings and make recommendations to pharmacy team.
d. Serve as the pharmacy HEDIS expert, including reviewing and updating data and materials for annual audit and accreditation.
e. Gather and submit MCAS data for annual submission to Division of Insurance.
f. Ensure that pharmacy policies and procedures are reviewed and updated annually, or as requested, for compliance purposes. Develop new policies and procedures, as needed.
g. Support corporate compliance and business ethics functions, including serving as a Compliance Team Member and Regulatory Compliance Liaison; assist business units in assuring compliance with applicable state and federal laws and regulations, and ethical business practices while encouraging innovation.
h. Attend pharmacy team meetings to provide the Wellmark pharmacy team updates on current compliance related issues and projects.
i. Collaborate with the Wellmark Compliance staff to support activities related to ethics and compliance matters related to the Medicare Advantage PDP business.
j. Participate and consult on pharmacy compliance related meetings or phone calls with the Compliance Office; research and provide data for audits as requested for internal and external audits.
k. Other duties as assigned.
