Compliance Specialist

Independent Health Association; Buffalo (NY); Hybrid; USD 62,000 - 73,000; Full time

Benefits offered by this job

scorecard incentive

full range of benefits

generous paid time off

Job summary

Independent Health Association is seeking a Compliance Specialist to oversee regulatory and contractual compliance for Reliance Rx pharmacy operations. You will research laws, track changes, and advise leadership on HIPAA and other requirements while coordinating licensing and credentialing activities.

The role requires strong drafting, analytical and communication skills, plus the ability to collaborate with internal teams and external regulators.

Qualifications

• Associate's degree required; two years in lieu accepted.
• Minimum three years in compliance, QA/audit or program management; healthcare exp preferred.
• Experience with pharmacy compliance, payor enrollment and regulatory requirements preferred.
• Strong research, drafting and analytical abilities for regulatory documents.

Responsibilities

• Monitor and research federal/state laws and guidance related to pharmacy operations and HIPAA.
• Track regulatory changes and coord with leaders to implement compliance requirements.
• Maintain knowledge of obligations and provide leadership with updates.
• Develop processes to monitor contractual obligations and regulatory needs.
• Coordinate contract review, negotiation, and ongoing administration with stakeholders.
• Support licensing renewals, PDMP waivers and credentialing processes.

Skills

Research skills

Analytical skills

Communication skills

Interpersonal skills

Project management

Initiative

Education

Associate's degree

Tools

Microsoft Office

Job description

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Overview

The Compliance Specialist shall be responsible for the overall execution, administration and monitoring of the compliance programs as it relates to contractual and general/pharmacy regulatory compliance to necessitate companywide adherence. The Compliance Specialist will support various contract and regulatory activities. The Compliance Specialist will report to the Deputy Counsel-Regulatory Compliance Manager and under their direction will be the liaison between Reliance Rx business units, the parent company Compliance Department and related departments, and applicable outside vendors or regulatory bodies related to these compliance matters.

They will conduct regulatory research and analysis as it relates to proposed, pending or effective laws, rules, and regulations impactful to Reliance Rx pharmacy operations. The position will work closely with the Reliance Rx Leadership Team to ensure leadership is appraised of and in compliance with regulations governing Reliance Rx programs, as well as work closely with the pharmacy team, business development, and internal audit to ensure compliance with relevant regulations and contractual provisions.

Qualifications

• Associate's degree required. An additional two (2) years of experience will be considered in lieu of degree.
• Three (3) years of compliance, quality assurance/audit or program/process management experience required. Healthcare experience preferred.
• Experience with specialty pharmacy/pharmacy preferred.
• Experience with payor and regulatory enrollment and maintenance preferred.
• Advanced computer and Windows skills required. Experience with Microsoft Office applications and demonstrated ability to learn new software applications.
• Excellent research skills and ability to exercise independent judgement to determine which changes in regulatory landscape should be presented in collateral and training.
• Excellent analytical skills, ability to analyze components of legislation and implement and draft necessary policies and procedures based upon regulatory requirements.
• Excellent composition and drafting skills, with emphasis on various compliance/regulatory documents and correspondence.
• Excellent communication skills, both verbal and written, and excellent interpersonal skills.
• Ability to effectively build and maintain relationships with both internal and external stakeholders.
• Proficiency in performing necessary research and preparing substantive work which requires knowledge of compliance concepts, with emphasis on HIPAA.
• Possess initiative, creativity, project management and organizational abilities.
• Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, Supportive.

Essential Accountabilities

• Monitor and research federal and state laws, regulations, and guidance related to pharmacy operations, specialty pharmacy, distribution, 340B, Medicare, Medicaid, HIPAA, and other applicable regulatory requirements.
• Track regulatory changes and coordinate with operational leaders, pharmacists, and other stakeholders to communicate, implement, and maintain compliance with new and existing requirements.
• Maintain subject matter knowledge of compliance obligations and provide recommendations, guidance, and updates to leadership as needed.
• Develop and maintain processes to monitor compliance with contractual obligations and regulatory requirements.
• Collaborate with Compliance, Finance, Business Development, and other stakeholders during contract review, negotiation, implementation, and ongoing administration.
• Facilitate contract processing, document management, compliance obligation tracking, and required approvals, revisions, signatures, and record retention.
• Research regulatory requirements for Reliance Rx to support acquisition and maintenance of Medicare and Medicaid enrollment(s) in all states and US territories.
• Support resident and non-resident pharmacy state licensing renewals processing accurately and in a timely manner.
• Support timely completion and renewal of state PDMP waivers or alternative zero reporting.
• Coordinate internal resources and complete required updates to licensing and credentialing entities regarding changes in corporate information, changes to pharmacy staff or other relevant personnel, changes in hours, and related updates.
• Support maintenance of tracking mechanisms regarding licensing and credentialing.
• Ensure timely renewal and ad hoc updates to the business NCPDP profile are completed.
• Complete and facilitate all necessary application and documentation requirements for the timely submission of initial and renewal payor credentialing.
• Develop and maintain tracking and monitoring processes to ensure compliance with business operations, application and renewal requirements, including coordination with other departments.
• Support the development, implementation, and communication of the organization's compliance, privacy, and security programs in coordination with parent Compliance and Information Risk teams.
• Manage compliance policies and procedures, including drafting, review, updates, regulatory citation validation, and organization of related documentation.
• Develop and maintain compliance metrics, dashboards, tracking tools, and process improvements to support program effectiveness and regulatory oversight.
• Coordinate compliance training, onboarding, annual education, attestations, assessments, and awareness activities for associates.
• Serve as a liaison between business units and parent Compliance, facilitating committee activities, issue escalation, investigations, corrective action plans, and regulatory inquiries.
• Support privacy and security monitoring, incident reporting, remediation efforts, audits, and government investigations as required.
• Act as the primary point of contact for associate compliance, privacy, security, and conflict-of-interest inquiries and concerns.
• Collaborate with operational teams, data management, and internal audit to support compliance-related system access, controls, and oversight.

This is a hybrid position with onsite attendance required at our Williamsville location. Immigration or work visa sponsorship will not be provided for this position. Hiring Compensation Range: $30.00 - $35.00 hourly.

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off.

• scorecard incentive
• full range of benefits
• generous paid time off

The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Aff… race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.