Healthcare Compliance Analyst — Medicare & CMS

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

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.