Compliance Associate

PharmPix Corp; Guaynabo (PR); On-site; USD 55,000 - 75,000; Full time

Job summary

PharmPix Corp. is seeking a detail-oriented Compliance Associate to support and strengthen our regulatory program in a healthcare environment, focusing on PBM, Health Plan, or Medicare settings.

The role emphasizes adherence to federal and state regulations, internal policies, and Medicare-related requirements. The ideal candidate will monitor regulatory changes, draft and manage agreements, participate in audits, and develop SOPs while collaborating with cross-functional teams.

Qualifications

• Bachelor's degree in Healthcare Administration, Law, Paralegal Studies, or related field.
• 1–3 years of experience in a PBM, Health Plan, Managed Care, or Medicare environment.
• 1–2 years of experience reviewing and managing contractual agreements.
• Working knowledge of CMS regulations, Medicare compliance requirements, and HIPAA.

Responsibilities

• Support the implementation, monitoring, and oversight of the organization's Compliance Program.
• Monitor and interpret regulatory changes affecting PBM operations, including CMS, HIPAA, and Medicare Part D requirements.
• Assist in maintaining compliance with Medicare regulations, reporting requirements, and audit readiness activities.
• Draft, review, and track agreements, amendments, and other legal or compliance-related documents.
• Conduct internal compliance reviews and audits to ensure adherence to applicable policies and procedures.
• Maintain documentation related to compliance activities, investigations, complaints, and corrective actions.
• Prepare compliance reports and presentations for leadership.
• Assist with internal and external audits, including CMS, URAC, and other regulatory reviews.
• Develop, maintain, and communicate compliance policies, procedures, and standard operating procedures (SOPs).
• Facilitate employee education and training on compliance-related topics.
• Collaborate with cross-functional teams to identify, mitigate, and address compliance risks.
• Support special projects and other duties as assigned by the Compliance Director.

Skills

Bilingual English/Spanish

Regulatory compliance

Microsoft Office proficiency

Education

Bachelor's degree in Healthcare Administration, Law, Paralegal Studies, or related field

Tools

Excel

Word

PowerPoint

Job description

We are seeking a detail-oriented and proactive Compliance Associate to support and strengthen our organization's Compliance Program. This role is responsible for ensuring adherence to federal and state regulations, contractual obligations, internal policies, and Medicare-related requirements. The ideal candidate will have experience in the healthcare industry, particularly within a PBM, Health Plan, or Medicare environment, and will be passionate about promoting ethical business practices and regulatory excellence.

Key Responsibilities

• Support the implementation, monitoring, and oversight of the organization's Compliance Program.
• Monitor and interpret regulatory changes affecting PBM operations, including CMS, HIPAA, and Medicare Part D requirements.
• Assist in maintaining compliance with Medicare regulations, reporting requirements, and audit readiness activities.
• Draft, review, and track agreements, amendments, and other legal or compliance-related documents.
• Conduct internal compliance reviews and audits to ensure adherence to applicable policies and procedures.
• Maintain documentation related to compliance activities, investigations, complaints, and corrective actions.
• Prepare compliance reports and presentations for leadership.
• Assist with internal and external audits, including CMS, URAC, and other regulatory reviews.
• Develop, maintain, and communicate compliance policies, procedures, and standard operating procedures (SOPs).
• Facilitate employee education and training on compliance-related topics.
• Collaborate with cross-functional teams to identify, mitigate, and address compliance risks.
• Support special projects and other duties as assigned by the Compliance Director.

Qualifications

Required

• Bachelor's Degree in Healthcare Administration, Law, Paralegal Studies, or related field.1-3 years of experience in a PBM, Health Plan, Managed Care, or Medicare environment.
• 1-2 years of experience reviewing and managing contractual agreements.
• Bilingual proficiency in English and Spanish (written and verbal).
• Working knowledge of CMS regulations, Medicare compliance requirements, and HIPAA.
• Strong Microsoft Office 365 skills, particularly Excel, Word, and PowerPoint.

Preferred

• Certified Compliance & Ethics Professional (CCEP) certification.
• Experience supporting regulatory audits and compliance investigations.

What Will Make You Successful

• Strong analytical and problem-solving skills.
• Exceptional organizational and time-management abilities.
• Excellent written and verbal communication skills.
• Ability to handle confidential information with professionalism and integrity.
• Comfortable presenting and providing training to diverse audiences.
• Ability to work independently while collaborating effectively with cross-functional teams.

Why Join Us?

Join a mission-driven organization committed to regulatory excellence, ethical business practices, and high-quality healthcare services. You'll have the opportunity to work closely with leadership, contribute to impactful compliance initiatives, and grow your career in a dynamic healthcare environment.

• Professional office environment with regular use of standard office equipment.
• May require occasional evening or weekend work to support audits, regulatory deadlines, or business needs.
• Ability to remain seated for extended periods and occasionally lift up to 50pounds.
• Reasonable accommodations may be provided to qualified individuals with disabilities to perform the essential functions of the position.

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable /Veterans