Healthcare Compliance Associate - Medicare & CMS Focus

PharmPix Corp; Guaynabo (PR); On-site; USD 65,000 - 90,000; Full time

Job summary

PharmPix Corp is seeking a detail-oriented Compliance Associate to support and strengthen our Compliance Program. You will ensure adherence to federal and state regulations, contractual obligations, and Medicare-related requirements in a healthcare environment.

The role focuses on monitoring regulatory changes, assisting audits, drafting agreements, and maintaining SOPs. Ideal candidates have PBM/Medicare experience and bilingual English/Spanish communication skills to collaborate across teams.

Qualifications

• Bachelor's degree in health admin, law, paralegal, or related field.
• 1-3 years of PBM/Health Plan/Medicare experience.
• 1-2 years reviewing and managing contractual agreements.
• Bilingual 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.

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

MS Office (Excel/PowerPoint)

Education

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

Job description

PharmPix Corp is seeking a detail-oriented Compliance Associate to support and strengthen our Compliance Program. You will ensure adherence to federal and state regulations, contractual obligations, and Medicare-related requirements in a healthcare environment.

The role focuses on monitoring regulatory changes, assisting audits, drafting agreements, and maintaining SOPs. Ideal candidates have PBM/Medicare experience and bilingual English/Spanish communication skills to collaborate across teams.