Regulatory and Compliance Analyst

Regulatory and Compliance Analyst is needed to perform the following duties:

· Attending the Insurance audits and providing them the necessity documents as proof of compliance with Regulatory requirements.

· Reviewing and assisting with Rx billing, DME billing, and insurance claims to ensure accuracy and compliance with applicable laws, regulations, payer requirements, and organizational policies; evaluating customer, payer, and vendor activities for compliance risks and discrepancies.

· Resolve the discrepancies findings responded by PDMP software.

· Reviewing and responding to audit findings by submitting supporting records to validate claims, resolve discrepancies, and justify pharmacy payment deductions.

· Checking the PDMP website before dispensing the controlled Rx’s and submission of the claims to PDMP website through Prime Rx system on daily basis to facilitate the regulatory bodies to find opioid overuse by Patients.

· State inspection and OIG inspection handling by submitting current employee’s information certifications (HIPPA, FWA), background checking, the e-signature logs for Rx’s, copies of Rx’s required by the auditors.

· Keep updates with new compliance requirements and review the compounding of the prescriptions looking for discrepancies, if any in what being dispenses and the prescription provided by the Physician.

· Execute the strategic and compliance plans for the company with particular emphasis on achieving overall profitability with sales and future expansion.

· Coordinating periodic compliance meetings with pharmacy staff and pharmacists to assess current requirements and prepare for regulatory updates from relevant authorities.

· Monitoring and evaluating operational metrics, contract reporting requirements, and vendor pricing to identify compliance and financial risks and communicate findings to management.

· Generating and Supervising regulatory compliance efforts within scope of responsibility across the Pharmacy.

· Ensure biannual licensure renewals and other ongoing required education.

· Develop compliance related program with changing regulatory bodies.

· Tracking data and creating reports to assist in the analysis of compliance and safety issue including but not limited to ongoing regulatory monthly inspections, tracers, adverse event reporting.

· Ensuring and evaluating state and federal policy compliance including

· Food Drug Administration

· Drug Enforcement Agency

· Centers for Medicare and Medicaid services

· Fraud, waste and abuse

· OGI, Prescription drug monitoring prigram

· Medication therapy management

· Outcomes management and Patient compliance

· Use of Outcomes MTM for possible overuse and therapy management.

· Periodically make follow up and medication related event review.

· Review and assist Pharmacists with loss or theft of controlled substances with form DEA-106 of federal controlled Substances.

· Assist in inventory of controlled substance of class CII, CIII, CIV, CV.

· Updating inventories for regular and controlled medicines every 6 months.

· Assist the employees in recall of medication and its return procedures.

Master's Degree is required in Pharmacy or Drug Regulatory Affairs or Pharmaceutical Science or Pharmacy Administration

Pay: $40.76 per hour

Expected hours: 20.0 – 30.0 per week

Work Location: In person