Compliance Analyst – Corrections

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SmithRx

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $20M Series B on 2022-03

Consulting • Insurance • Healthcare

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

📋 Description

• Design and/or enhance corrective action process • Assess and prioritize corrective action referrals • Initiate corrective actions, including corrective action plans and warning letters • Collaborate with business stakeholders to perform root cause analysis • Identify prevention, detection, and correction opportunities • Ensure business partners complete corrective actions in a timely and effective manner • Identify ways to mitigate organizational risks • Develop job aids, playbooks, and other program documentation • Build and maintain positive and strategic relationships with internal and external stakeholders • Support a compliant and ethical culture • Assist in developing or updating oversight materials and reporting metrics • Create and distribute written compliance standards where applicable • Abide by organization retention standards and version controls • Collaborate in Compliance training and education needs • Investigate potential or reported non-compliance issues • Monitor organizational disciplinary actions and incentives for consistency, accuracy, and timeliness • Collaborate with Legal and other stakeholders to interpret regulations • Perform other responsibilities as assigned • Report to the Compliance Director

🎯 Requirements

• Bachelor’s degree or higher education in healthcare, compliance, or a related field, or equivalent years of relevant work experience is required • Minimum of four (4) years of compliance experience at a PBM or health plan • Pharmacy operations oversight or similar experience would be considered • Direct experience with pharmacy benefits, network, and claims is a bonus • CHC, CHPC, or CCEP certification preferred • Current, unrestricted clinical or functional business licensure is a bonus • Strong understanding of the seven elements of a highly effective compliance program • Strong familiarity with PBM-related healthcare operations and/or clinical concepts, practices, and procedures preferred; similar health plan knowledge considered • Strong working knowledge of healthcare compliance program corrective actions • Working knowledge of external audit functions and procedures • Strong familiarity with ERISA, Healthcare Exchange Marketplace (Affordable Care Act), Worker’s Compensation, and Medicare preferred • Familiarity with pharmacy operations and healthcare benefits • Professional verbal and written communication skills • Advanced organizational, project, and time management skills • Ability to work independently and within a team environment • Ability to establish effective collaborative techniques, such as conflict resolution • Ability to sit or stand for extended periods of time • Occasional travel or visits to SmithRx offices may be required

🏖️ Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • 12 Paid Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities • Bonuses, commissions, or equity may be available • Time off programs • Mental health support