Compliance Analyst - Pharmacy

Wellmark, Inc.; Iowa; Hybrid; USD 70,000 - 100,000; Full time

Job summary

Wellmark, Inc. is seeking a Pharmacy Compliance Analyst to join our Pharmacy Services team. This role partners with Legal, Regulatory Compliance, Pharmacy Quality Assurance, and broader Pharmacy to ensure regulatory compliance and respond to audits.

You will research, track, and report compliance inquiries and coordinate across the organization to remediate issues. Ideal candidates have strong project management and communication skills, with 4+ years in health insurance or related fields, and a

Qualifications

• Bachelor’s degree or direct and equivalent work experience.
• 4+ years of health insurance, health care, or related industry experience with rules and policies.
• Strong analytical skills to recognize inconsistencies and derive conclusions.
• Aptitude to learn on compliance best practices in pharmacy.

Responsibilities

• Manage day-to-day regulatory compliance related to pharmacy, coordinating with leadership and staff to report on status and resolution.
• Support oversight of Exchange tasks including CMS audits and audit findings recommendations.
• Serve as the NCQA expert: gather evidence for annual submission and audits.
• Serve as the HEDIS expert: review and update data for audits and accreditation.
• Gather and submit MCAS data for annual submission to Division of Insurance.
• Ensure pharmacy policies are updated annually; develop new policies as needed.
• Support corporate compliance and ethics functions and advise business units on laws and ethics.
• Attend pharmacy team meetings to provide updates on compliance issues and projects.
• Collaborate with Compliance staff on Medicare Advantage PDP business matters.
• Participate in and document audits as requested for internal and external audits.

Skills

Regulatory analysis

Project management

Communication

Microsoft Office

Education

Bachelor's degree

Tools

CMS audit software

Data analysis tools

Job 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.

Learn more about our unique benefit offerings here.

Use Your Strengths at Wellmark as a Compliance Analyst on our Pharmacy team!

About the opportunity: Are you a healthcare compliance professional seeking a new, exciting opportunity to join a fast-growing department? Wellmark is hiring a Pharmacy Compliance Analyst for our evolving Pharmacy Services team! In this role, you will closely partner with team members in Legal, Regulatory Compliance, Pharmacy Quality Assurance, and the broader Pharmacy department, to ensure regulatory compliance. You will also respond to and assist with requests for regulatory and group audits as needed. You will research, track, and report compliance inquiries; collect internal and external data; and coordinate peers and partners across the organization to drive remediation of identified compliance issues through resolution. Collaboration and building internal partnerships are key to success in this role.

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, addressing both up and downstream impacts. You are highly organized, and you effectively prioritize work to timely complete initiatives. Project management skills are essential. You actively build partnerships across the organization and thrive in a collaborative environment balanced with a role where taking initiative is important. You will have ownership of your work and have a seat at the table for introducing creative recommendations on challenging regulatory needs. Pharmacy and/or health insurance compliance or risk experience is a plus!

Hybrid environment:

This position will work a hybrid schedule of at least 3 days (Tuesday, Wednesday, Thursday) in Wellmark's Des Moines office, with 2 days (Monday, Friday) remote option.

Preferred Qualifications - Nice to have:

• Pharmacy related compliance experience.

Required Qualifications - Must have:

• Bachelor’s degree or direct and equivalent work experience.
• 4+ years of health insurance, health care, or related industry experience, including reading, understanding, applying and/or communicating established rules, regulations, guidelines, or policies.
• Demonstrated analytical skills to recognize inconsistencies, research and come to a conclusion, and careful attention to detail.
• Aptitude to learn and stay current on compliance best practices and industry regulations as it relates to pharmacy.
• Strong verbal and written communication skills, including but not limited to, developing written communication and presenting to various internal and external audiences. Strong documentation skills.
• Flexible, adaptable, and able to effectively manage multiple priorities in a fast-paced environment through effective time management and organization.
• Proficiency with Microsoft Office – e.g., Outlook, Excel, Word. Technical aptitude to learn new systems quickly.

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.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [e-mail]

Please inform us if you meet the definition of a 'Covered DoD official'.

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources: Nonimmigrant Workers and Green Card for Employment-Based Immigrants

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.