Compliance Specialist

ih; United States; Hybrid; USD 80,000 - 120,000; Full time

Job summary

Reliance Rx is seeking a Compliance Specialist to oversee regulatory compliance across contracts and pharmacy operations. You will monitor federal and state requirements, coordinate with leaders, and support licensing and credentialing.

This role requires strong research, drafting, and communication skills, plus the ability to work with internal teams and external regulators. Experience in healthcare/pharmacy compliance is preferred and attention to HIPAA matters is essential.

Qualifications

• Associate's degree required; two years of experience may substitute.
• Three years of compliance, quality assurance/audit or program/process management experience required.
• Healthcare/pharmacy experience preferred.
• Payor and regulatory enrollment experience preferred.
• Advanced computer skills; ability to learn new software applications.
• Excellent research, analytical, drafting and communication skills.
• Ability to build relationships with internal and external stakeholders.
• Knowledge of HIPAA and regulatory concepts.

Responsibilities

• Monitor and research federal and state laws, regulations and guidance related to pharmacy operations, specialty pharmacy, distribution, Medicare, Medicaid, HIPAA and other regulatory requirements.
• Track regulatory changes and coordinate with leaders to communicate and implement compliance.
• Maintain knowledge of compliance obligations and provide guidance to leadership.
• 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 and renewal.
• Facilitate contract processing, document management, and record retention.
• Research regulatory requirements to support enrollment in Medicare/Medicaid in all states.
• Support licensing renewals and credentialing updates as needed.
• Coordinate updates to licensing/credentialing entities for personnel changes.
• Develop tracking/monitoring processes to ensure compliance with business operations.

Skills

Regulatory research

HIPAA knowledge

Analytical skills

drafting policies

Communication

Relationship building

Microsoft Office

Independent judgement

Project management

Healthcare compliance

Education

Associate's degree

Tools

Microsoft Office

Job description

FIND YOUR FUTURE

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 requir