Compliance Specialist

Job Title: Compliance Specialist

Location: Remote

FLSA Status: Non-Exempt

Job Summary

Within the Network Compliance team, the Compliance Specialist is responsible for ensuring AlignRx pharmacy member network compliance with appropriate documentation, providing exceptional customer service during the recredentialing process, and completing special projects.

Essential Job Functions

  • Maintaining required credentialing information to ensure in-network pharmacies are compliant to remain in AlignRx pharmacy network.
  • Assist pharmacies with the Compliance application/completion of an event.
  • Conduct primary source verification of licensure and disciplinary status.
  • Verify accuracy of pharmacy information in database.
  • Maintain and update pharmacy agreements and electronic documents.
  • Create recredentialing events, service adds, bank changes, DBA/location change events.
  • Process Phase 1 and Phase 2 of recredentialing events and ensure completion of events.
  • Complete associated recredentialing processes, including but not limited to, primary source verification and google map review.
  • Monitor for red flags (e.g., credit issues) identified through the enrollment process, notifying the Compliance Manager via the management review process.
  • Verify OIG/SAM is clear during recredentialing process.
  • Oversee affiliation process between NCPDP, PBMs, and AlignRx to ensure timely affiliation of pharmacies to all AlignRx chain codes and PBM agreements.
  • Determine if an updated Pharmacy Services Agreement is required. If yes, send new agreement to pharmacy owner for execution.
  • Send internal notice for service adds to departments impacted, facilitating new service welcome calls.
  • Address phone and email inquiries from pharmacy owners completing the recredentialing process.
  • Answer pharmacy calls in the phone queue and address any inquiries or issues.
  • Monitor the recredentialing inbox and recredentialing PDMS notes report.
  • Monitor individual PDMS notes.
  • Complete special projects as assigned.
  • Assist in the FWA review process as needed, gathering information for the committee.
  • Research PIC changes and update PDMS, notify Affiliation team, escalate any issues to management for review.
  • Record reported discipline in PDMS, notify Affiliation team, escalate any issues to management for review.
  • Update PDMS with any new service adds.
  • Implement all job duties in accordance with the Network Management defined policy and procedures.
  • Report any questionable pharmacy activity to the AlignRx Fraud, Waste, and Abuse (FWA) Committee.

Minimum Qualifications

  • CPhT or National Technician Certification required.
  • High school graduate; college degree preferred.
  • Two or more years’ experience as a pharmacy technician in a retail/community pharmacy environment.
  • PBM experience a plus.

Additional Responsibilities

  • Other duties and projects as required by management.

Knowledge, Skills & Abilities

  • Effective verbal and written communication skills.
  • Good interpersonal skills: able to work and communicate with co-workers and external contacts.
  • Strong organization and time management skills.
  • Efficient analytic skills.
  • Good problem-solving skills.

  • Must be detail-oriented.

  • Good customer service skills.

  • Must demonstrate dependability through good attendance.

  • Must be able to adhere to strict deadlines, timelines, schedules.

  • Effective management of projects and deliverables.

  • Basic computer knowledge through effective use of a personal computer, including Microsoft Office applications; specifically, file management skills, Internet, Microsoft Windows, database, Microsoft Office 365.

Physical Requirements/Working Conditions

This work is sedentary and requires the following physical activities:

  • Sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.
  • Remote office environment/or telework.

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.

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Compliance Specialist