Compliance Analyst - Pharmacy

Use Your Strengths at Wellmark as a Compliance Analyst for Pharmacy! 

About the opportunity: Are you a healthcare compliance professional seeking a new exciting opportunity to join a fastgrowing team Wellmark is looking to add a Pharmacy Compliance Analyst to our evolving Pharmacy Services team! In this key role you will work in partnership with our Legal/Compliance teams and the Quality Program & Accreditation team to ensure compliance across the Pharmacy department. You will respond to and assist with requests for regulatory audits. You will research track report and resolve inquiries plus collect internal and external data on compliance needs to further address and find resolutions.  

About you: You are inquisitive and a natural critical thinker. You have the keen ability to review regulatory guidelines and understand the potential business impact of the changes. You are incredibly organized and you effectively prioritize work to complete initiatives timely. You actively build partnerships across the organization and thrive in a collaborative environment balanced with a role where taking initiative is important.  

Pharmacy and/or health insurance compliance or risk experience is a plus! 

This position will work a hybrid schedule of at least 3 days in Wellmarks Des Moines office with 2 days remote option.

Qualifications :

Preferred Qualifications Nice to have:

• Pharmacy related compliance experience.

Required Qualifications Must have:

• Bachelors 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 fastpaced environment through effective time management and organization.
• Proficiency with Microsoft Office e.g. Outlook Excel Word. Technical aptitude to learn new systems quickly.

Additional Information :

What you will do as a Compliance Analyst for Pharmacy:

a. Manage daytoday 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 Employer

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