Compliance Specialist

The Compliance Specialist II is responsible for supporting the organization’s compliance program with a primary focus on specialty pharmacy and patient care regulatory oversight. This role partners with business owners to help ensure adherence to federal and state regulatory requirements, payer contractual obligations, and government required accreditation standards specific to specialty pharmacy services. The Specialist performs regulatory analysis, auditing, monitoring, risk assessments, issue resolution, policy/procedure assistance and compliance education while serving as a subject matter expert for specialty pharmacy-related compliance requirements. We are looking for a Compliance Specialist with: Experience: 4+ years in payer compliance, pharmacy, or clinical operations. Education: Bachelor’s degree or equivalent work experience. Preferred Experience Experience with Medicare Part D or pharmacy accreditation preferred. Leadership experience preferred. Certification in healthcare compliance or Pharmacy Tech certification preferred. Licensure as a RN preferred. Core Competencies Regulatory analysis Audit and risk assessment Communication and training Analytical problem solving Key Responsibilities Regulatory Oversight & Analysis Analyze and interpret federal and state pharmacy regulations including but not limited to: CMS, FDA, State Boards of Pharmacy, and DOI. Provide consultative assistance related to implementation for operations. Maintain awareness of REMS programs and specialty drug compliance requirements. Compliance Program Execution Coordinate compliance risk assessments for specialty pharmacy functions. Support monitoring and auditing work plans. Partner with business owners to ensure regulatory requirements are integrated into policies and procedures. Coordinate compliance efforts with Pharmacist in Charge. Auditing & Monitoring Conduct, coordinate and/or review audits of dispensing, documentation, and patient outreach. Analyze findings and recommend corrective actions. Support external audits including CMS and accreditation reviews. Issue Resolution & Risk Mitigation Investigate compliance issues and perform risk ranking. Develop corrective action plans with stakeholders. Track remediation efforts through completion. Training & Communication Provide information to Corporate Compliance on training including FWA and HIPAA. Distribute regulatory updates and communications. Work with Pharmacist in Charge to develop training as needed. Stakeholder Collaboration Advise and/or consult with pharmacy operations and leadership. Collaborate with PBMs, manufacturers, and vendors. Promote compliance best practices. As of the date of this posting, a good faith estimate of the current pay range is $78,064 to $117,095. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Blue Cross of Idaho has taken our role as an Idaho-based health insurance company to heart since 1945. As a not-for-profit, we are driven to help connect Idahoans to quality and affordable healthcare while building strong networks and services. We aim to create a brighter future for all with the help of customer-centric professionals. Your Health and Wellness Matters At Blue Cross of Idaho, we care about the health and well-being of our employees. Our benefits aim to help make your life easier, healthier and more balanced. Your Career Development Matters We believe in employee growth, which is why we offer training, tools and numerous resources to assist with professional development. Your Community Matters Our employees care deeply about Idaho. We work together to positively impact communities throughout Idaho, and contribute our time through volunteering. Blue Cross of Idaho will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully use electronic and online job application systems. For assistance, please send an email to View email address on click.appcast.io. Equal Opportunity is the Law EEO is the Law Supplement E-Verify Pay Transparency