Compliance Analyst

We are looking for a Compliance Analyst to assist in all operational aspects of implementing a highly-effective compliance program in a dynamic PBM regulatory landscape. This position will focus on successful remediation of identified non-compliance with regulatory requirements and company policies and procedures.

In this role, you will assist, build, and lead initiatives which correct and mitigate organization risks using the key seven elements of a compliance program. You will work closely with the Corporate Compliance department and business areas across the organization to support our mission.

We are looking for someone who is enthusiastic about building and supporting programs that impact pharmacy and other healthcare benefits at a high-growth healthcare technology company. This is a remote, full time position and you may be required to sit or stand for extended periods of time. On rare occasions, this position may travel or visit any of the SmithRx offices, including the home office in San Francisco, California. This position reports to the Compliance Director.

What you will do:

Primary Responsibilities:

• Design and/or enhance corrective action process
• Assess and prioritize corrective action referrals
• Initiate corrective actions (e.g., corrective action plans, warning letters)
• Collaborate with business stakeholders to perform root cause analysis
• Collaborate with business stakeholders to identify prevention, detection, and correction opportunities
• Ensure business partners complete corrective actions in a timely and effective manner
• Identify ways to mitigate risks to our organization
• Develop job aids, playbook, and other program documentation

Additional Responsibilities:

• Build and maintain positive and strategic relationships with internal and external stakeholders
• Support our compliant and ethical culture
• Assist in developing or updating oversight materials and reporting metrics
• Create and distribute written compliance standards where applicable
• Abide by organization retention standards and version controls
• Collaborate in Compliance training and education needs
• Investigate potential or reported issues of non-compliance
• Monitor organizational disciplinary actions and incentives for consistency, accuracy, and timeliness
• Collaborate with Legal and other stakeholders to interpret regulations
• Other responsibilities as assigned

What you bring:

Education and Experience:

• Bachelor’s degree or higher education in healthcare, compliance, or a related field, or equivalent years of relevant work experience is required
• Minimum of 4 years of compliance experience at a PBM or health plan, and pharmacy operations oversight or similar experience would be considered
• Direct experience with pharmacy benefits, network, and claims is a bonus

Licensing or Training:

• Certified in Healthcare Compliance (CHC), Certification in Healthcare Privacy Compliance (CHPC), or Certified Compliance and Ethics Professional (CCEP) preferred
• Current, unrestricted clinical or functional business licensure is a bonus (examples: certified pharmacy technician)

Hard and Soft Skills:

• Strong understanding with the seven elements of a highly effective compliance program
• Strong familiarity with PBM-related healthcare operations and/or clinical concepts, practices and procedures is preferred, or similar health plan knowledge will be considered
• Strong working knowledge of healthcare compliance program corrective actions
• Working knowledge of external audit functions and procedures
• Strong familiarity with ERISA, Healthcare Exchange Marketplace (Affordable Care Act), Worker’s Compensation, and Medicare preferred
• Familiarity with pharmacy operations and healthcare benefits
• Data-driven, big-picture thinker, and solutions-oriented
• Professional verbal and written communication skills including proper grammar, construct, and appropriate to the audience
• Advanced organizational, project, and time management skills to prioritize, prepare, and leverage resources and stay on focus
• Ability to work independently and within a team environment
• Ability to establish effective collaborative techniques, such as conflict resolution