Company Overview:
RiteChoice Pharmacy is a solutions-based 340b contract pharmacy company dedicated to providing exceptional patient care, innovative solutions, and advancing healthcare outcomes. We are committed to improving the health and well-being of individuals and communities through our comprehensive range of services.
Position Overview:
We are seeking a highly skilled and experienced Director of Compliance and Audit to oversee and manage our compliance and audit functions. The Director of Compliance and Audit will be responsible for ensuring that our operations adhere to all applicable laws, regulations, and industry standards. This role will involve developing and implementing compliance policies and procedures, conducting audits and assessments, and providing guidance to the organization on compliance matters.
You will oversee both internal and third-party audits, ranging in scope from prescription audits, processes audits, inventory audits, and claims audits, 340B and workflow compliance, credentialing with PBMs and PBM provider manual expertise. You will lead a team of compliance, credentialing and auditing professionals in the ongoing pursuit of process improvement and alignment to the ever changing regulatory landscape.
Additionally, you will participate in the expansion efforts for RiteChoice into both new practice areas and new territories. You will be working directly with RiteChoice leadership to improve pharmacy processes and ensure general pharmacy compliance to promote company growth. This is a full-time on-site position at our corporate headquarters in Philadelphia.
Key Responsibilities:
Develop and implement comprehensive compliance policies and procedures to ensure adherence to all relevant regulations and standards, including but not limited to, state and federal pharmacy laws, HIPAA, and DEA regulations.
Conduct regular audits and assessments of our operations to identify areas of non-compliance and implement corrective actions as needed.
External claims auditing from CMS, PBMs, and other third parties to ensure the appropriateness and accuracy of submitted pharmacy claims.
Validating overpayments are refunded to the appropriate third-party plan, Medicaid or CMS program within 60 days as per Affordable Care Act 2010.
Internal auditing of billing and claims, operational processes and workflows.
Documentation audits to ensure proper 340B compliance.
Inventory auditing to ensure accurate counts of CII, CIII, CIV and CV drugs.
Pharmacy auditing to ensure systems and workflows are running effectively and efficiently.
Provide guidance and training to staff on compliance requirements and best practices.
Collaborate with internal stakeholders to ensure that compliance considerations are integrated into business processes and decision-making.
Serve as the primary point of contact for all aspects of credentialing for facilities and staff.
Stay informed about changes in regulatory requirements and industry standards and ensure that our policies and procedures are updated accordingly.
Monitor compliance metrics and prepare regular reports for senior management, highlighting areas of concern and opportunities for improvement.
Maintain strict compliance of HIPAA/PHI regulations.
Working with Elevate Provider Network regarding medication reconciliation and identifying potential MTM opportunities by using MTM outcomes.
Foster a culture of compliance and ethical behavior throughout the organization, promoting awareness and accountability at all levels.
Qualifications:
PharmD or JD degree. Bachelor's degree in Pharmacy, Healthcare Administration, Business Administration, or a related field, will be considered.
At least 5-7 years of management experience in a compliance or audit role in pharmacy and/or healthcare industry, with a strong understanding of pharmacy regulations and standards.
Professional certification in compliance or audit (e.g., Certified in Healthcare Compliance [CHC], Certified Internal Auditor [CIA]) preferred.
Demonstrated experience developing and implementing compliance policies and procedures, conducting audits and assessments.
Excellent knowledge of state and federal pharmacy laws, HIPAA regulations, DEA requirements, and other relevant regulatory frameworks.
Strong analytical skills and attention to detail, with the ability to identify compliance risks and recommend effective solutions.
Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders at all levels of the organization.
Proven leadership abilities, with experience managing teams and driving results in a complex and dynamic environment.
Demonstrated proficiency in utilizing technology tools and platforms to enhance data analytics and reporting processes.
In depth experience utilizing Microsoft Suite.
Strategic mindset with the ability to think creatively and adapt to changing business environments.
Commitment to ethical conduct, integrity, and transparency in all financial matters.
Benefits:
RiteChoice offers a competitive compensation package, including salary, performance bonuses, and comprehensive benefits such as health insurance, retirement plans, and professional development opportunities.
Join our team and make a difference in healthcare! Apply now to become our next Director of Compliance and Auditing and contribute to our mission of improving patient outcomes and transforming the healthcare industry.th experience utilizing Microsoft Suite.
Strategic mindset with the ability to think creatively and adapt to changing business environments.
Commitment to ethical conduct, integrity, and transparency in all financial matters.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Experience:
- Compliance management: 7 years (Required)
Ability to Commute:
- Philadelphia, PA 19133 (Required)
Ability to Relocate:
- Philadelphia, PA 19133: Relocate before starting work (Required)
Work Location: In person