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Compliance Analyst

Company: Wellmark, Inc.
Location: Des Moines
Posted on: May 26, 2023

Job Description:

Company DescriptionInternal Job Title: Pharmacy Compliance AnalystWhy Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!Learn more about our unique benefit offerings here.Want to know more? You can learn about life at Wellmark here.Job DescriptionUse your strengths as a Pharmacy Compliance Analyst at Wellmark!About the opportunity: Are you a healthcare compliance expert seeking a new, exciting opportunity to join a fast-growing team? Wellmark is looking to add a Pharmacy Compliance Analyst within our evolving Pharmacy Services team! This key role will be the subject matter expert on all things "healthcare and pharmacy compliance" and work in partnership with our Legal/Compliance teams and the Quality Program & Accreditation team to ensure compliance across the Pharmacy team. You will research, track, report and resolve grievances, plus collect internal and external data on compliance needs to further address and find resolutions.Knowledge of HEDIS and NCQA standards and/or have experience consolidating and reviewing MCAS data is a plus!QualificationsRequired:Bachelor's degree or direct and equivalent work experience.4+ years of health insurance, health care, or related industry experience, including reading, understanding, applying and/or communicating established rules, regulations, guidelines, or policies.Demonstrated analytical skills to recognize inconsistencies, research and come to a conclusion, and careful attention to detail.Aptitude to learn and stay current on compliance best practices and industry regulations as it relates to pharmacy.Strong verbal and written communication skills, including but not limited to, developing written communication and presenting to various internal and external audiences. Strong documentation skills.Flexible, adaptable, and able to effectively manage multiple priorities in a fast-paced environment through effective time management and organization.Proficiency with Microsoft Office - e.g., Outlook, Excel, Word. Technical aptitude to learn new systems quickly.Preferred:Pharmacy related compliance experience.Additional Informationa. Manage day-to-day regulatory compliance related to pharmacy, according to established policies and procedures, by facilitating identification of and reporting on the status and resolution of pharmacy compliance issues through effective and timely coordination with leadership, pharmacy staff and Compliance Team members.b. Support pharmacy team in oversight of Exchange related tasks including downstream delegated entity (DDE) monitoring, JSON files, gathering documentation for CMS audits, reviewing audit findings and making recommendations to pharmacy team.c. Serve as the pharmacy NCQA expert, including gathering evidence for annual submission, review and ensure adherence to related policies & procedures, gather documentation for and participate in audits, review audit findings and make recommendations to pharmacy team.d. Serve as the pharmacy HEDIS expert, including reviewing and updating data and materials for annual audit and accreditation.e. Gather and submit MCAS data for annual submission to Division of Insurance.f. Ensure that pharmacy policies and procedures are reviewed and updated annually, or as requested, for compliance purposes. Develop new policies and procedures, as needed.g. Support corporate compliance and business ethics functions, including serving as a Compliance Team Member and Regulatory Compliance Liaison; assist business units in assuring compliance with applicable state and federal laws and regulations, and ethical business practices while encouraging innovation.h. Attend pharmacy team meetings to provide the Wellmark pharmacy team updates on current compliance related issues and projects.i. Collaborate with the Wellmark Compliance staff to support activities related to ethics and compliance matters related to the Medicare Advantage PDP business.j. Participate and consult on pharmacy compliance related meetings or phone calls with the Compliance Office; research and provide data for audits as requested for internal and external audits.k. Other duties as assigned.An Equal Opportunity EmployerThe policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at

Keywords: Wellmark, Inc., Des Moines , Compliance Analyst, Professions , Des Moines, Iowa

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