SmithRx

Compensation

Full Description

Job Description: • Design and/or enhance targeted and annual risk assessments • Develop risk methodologies, scoring, and prioritization • Construct specific and effective auditing and monitoring workplans based on risks identified • Perform timely auditing and monitoring activities • Analyze compliance outcomes and ensure detected issues are referred for remediation • Identify ways to mitigate risks to our organization • Coordinate external audits, as assigned • Create and run mock audits • Build and perform readiness testing exercises • Develop job aids, playbook, and other program documentation • 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 • Perform root-cause analysis and identify prevention, detection, and correction opportunities • Ensure business partners complete corrective actions in a timely and effective manner • Monitor organizational disciplinary actions and incentives for consistency, accuracy, and timeliness • Collaborate with Legal and other stakeholders to interpret regulations • Other responsibilities as assigned Requirements: • Bachelor’s degree or higher education in healthcare, compliance, or a related field, or equivalent years of relevant work experience is required • Minimum of four (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 • 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) • 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 audit and monitoring activities, compliance risk assessments • 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 Benefits: • Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • Paid Company Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities