Position Summary:
The Compliance Specialist performs activities in support of an effective privacy program across the Birdi enterprise. The primary responsibilities include conducting investigations, performing auditing and monitoring functions, assisting with the development and maintenance of privacy policies and privacy training programs.
Essential Duties/Responsibilities:
- Maintain programs, policies, and procedures related to compliance and privacy, ensuring adherence to state and federal regulations, accreditation standards, and industry standards.
- Maintain a strong understanding of state and federal pharmacy and privacy laws, regulations, guidelines and accreditation standards.
- Lead and/or participate in projects related to design, implementation, revision, maintenance, and training of processes and systems that promote compliance.
- Assist with the development of the Compliance Annual Work Plan and the Privacy Office Annual Work Plan to help identify, monitor and assess new and ongoing organizational compliance and privacy risks.
- Oversee intake and triage of compliance requests, prioritizing issues based on risk and coordinating follow-up actions.
- Communicate, monitor, and analyze data and reports of privacy incidents, compliance violations, and record requests.
- Conduct and document timely compliance and privacy investigations and prepare privacy incidents for breach analysis.
- Assist in the development, communication and implementation of corrective and preventative action plans.
- Maintain accurate and consistent documentation regarding all requests for patient records in compliance with applicable state and federal laws and regulations.
- Monitor and validate documentation of employee licensure and Primary Source Verifications (PSVs), ensure timely submission to Credentialing, and track licensure status through JD Reporting to identify and remediate missing or expired credentials.
- Develop and/or update policies and procedures as warranted and at a minimum review annually for accuracy.
- Monitor, track, and drive to completion compliance and regulatory initiatives arising from regulatory updates, accreditation requirements, and new operational programs.
- Develop and collaborate on procedures and work instructions and monitor and track Pharmacist’s Letter accounts to ensure compliance and proper access management.
- Work collaboratively with other departments and teams to ensure compliance across the organization, which may include assisting with outside audits, inspections, and surveys.
- Work efficiently to complete tasks in a fast-paced environment to meet scheduled deadlines.
- Other duties as assigned.
Required Skills/Abilities:
- Demonstrate knowledge of state and federal laws and regulations in pharmacy, pharmacy accreditation standards, pharmacy and medical billing, and inventory management.
- Strong analytical and critical thinking skills to analyze complex data, identify trends, and draw accurate conclusions.
- Excellent verbal and written communication skills to clearly explain audit findings and recommendations to pharmacy staff and management.
- A decisive individual possessing a detail-oriented perspective.
- Demonstrates superior organizational skills, priority setting, accomplishing work independently and reliably, and employing multi-task management.
- Ability to quickly learn and understand complex processes and systems.
- Excellent relationship management skills and emotional intelligence.
- Ability to relate to people at all levels of an organization and possesses excellent communication skills.
- Ability to exercise considerable judgment, maintain confidentiality, and act in a diplomatic manner.
- Ability to independently identify, research and resolve issues.
- Ability to work extended hours, weekends, and holidays in alignment with departmental and industry demands.
Education/Experience:
- Pharmacy technician certification with an accredited certifying body.
- Current pharmacy technician registration with the employee’s residing state board of pharmacy.
- At least 5 years of experience in Retail, Mail Order or Specialty Pharmacy, PBM, pharmaceutical or managed health care industry.
- Proficient in Microsoft Office and industry related software programs.
- Experience working in a cross-functional team environment.
Preferred Skill/Abilities:
- Certification as a Compliance Specialist.
- In-depth knowledge of pharmacy compliance, state and federal regulations and standards, pharmacy accreditation, and privacy policies and procedures.
- Experience or knowledge of relevant privacy laws, including HIPAA.
- Ability to research and understand complicated privacy incidents.
- Experience or knowledge of conducting, documenting and reporting a pharmacy or PBM audit.
Work Environment/Physical Requirements:
- Home-based office environment with minimal exposure to excessive noise or adverse environmental issues.
- Ability to sit for prolonged periods of time.