Compliance Specialist

Independent Health; United States; Hybrid; USD 85,962,000 - 100,289,000; Full time

Job summary

Independent Health is seeking a Compliance Specialist to oversee the execution and monitoring of contract and regulatory compliance for Reliance Rx pharmacy operations. You will serve as the liaison between business units, Compliance, Finance, and external regulators, guiding policies and procedures in line with HIPAA and 340B requirements.

The role requires an Associate degree and 3+ years in compliance or related fields, with strong research, drafting, and interpersonal skills.

Qualifications

• Associate’s degree required; 2 years of experience may substitute.
• 3+ years of compliance, QA/audit or program/process management experience.
• Healthcare experience preferred.
• Experience with payor and regulatory enrollment preferred.
• Excellent research and drafting abilities in compliance documents.
• Strong communication and interpersonal skills; ability to collaborate with internal and external stakeholders.

Responsibilities

• Monitor and research federal and state laws related to pharmacy operations and Medicare/Medicaid requirements.
• Communicate and implement changes with leaders and stakeholders to maintain compliance.
• Develop and maintain processes to monitor contractual obligations and regulatory requirements.
• Coordinate contract reviews, negotiations, and ongoing administration with multiple departments.
• Support licensing, credentialing, and PDMP waivers; track renewals and filings.
• Develop compliance training, attestations, and awareness activities for associates.

Skills

Regulatory research

HIPAA knowledge

Policy drafting

Communication skills

Analytical skills

Relationship building

Independent judgment

Education

Associate degree

Tools

Microsoft Office

Windows OS

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

Equal Opportunity and Diversity Statement

As an Equal Opportunity / Affluent AAP Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s 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.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans.

We do not accept unsolicited resumes.

We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

About Independent Health

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community. We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog. We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it.