Regulatory Performance Analyst II - Part D
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
Summary:
Subject matter expert (SME) in Medicare Part D/Commercial Pharmacy compliance. Responsible for communicating Medicare regulatory requirements to operational areas within their SME purview and conducting follow up to assure implementation. Analyzes and clarifies guidance as required for the business area and obtains clarification of guidance from CMS as appropriate. Identifies possible compliance issues, assists with investigation and resolution, escalating issues when appropriate. Assists with monitoring to measure compliance with CMS regulations and guidance, communicates findings to impacted business areas and completes follow up to assure resolution of the identified issues.
- Provide regulatory interpretation, analysis and make recommendations to management for all aspects of Medicare Part D/Commercial Pharmacy compliance
- Work proactively to ensure business areas falling within their purview are prepared for CMS audits, aware of current guidance and can produce a compliant universe
- Review indicators and other monitoring tools impacting their SME area, spot trends and identify potential compliance issues, providing feedback to business areas and escalating as required
- Effectively using the Corrective Action Plan policy and procedure to correctly and completely document identification and remediation of all compliance issues impacting their SME area
- Coordinate with business area to review regulations, implement corrections if necessary and track completion
- Develop Tracers for CPE audits with moderate supervision and assist business areas in doing the same
- Coordinate with business area partners to ensure reported issues are updated weekly on the CMS Disclosed Issues Grid
- Help ensure business areas within their SME purview are engaged and prepared to report results at all compliance committees and workgroups
- Act as a liaison between CMS Regional Offices and Independence when needed
QUALIFICATIONS
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- Bachelor’s degree in related field or equivalent work experience.
- Minimum of 3 years related work experience in managed care or health care, particularly experience working in a Pharmacy compliance/operational role at another health plan, or at a PBM.
- Excellent organizational, verbal and written communication skills required.
- Working knowledge of Microsoft Office products required. Previous compliance experience is preferred.
- Knowledge of Government Markets, and specifically the pharmacy industry, is an asset.
- Knowledge of Medicare Advantage Part D regulations.
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.