Independent Health · 2 days ago
Compliance Specialist - Senior
Buffalo, NY (14221)
Full-time
Hybrid
Mid, Senior Level
$30/hr - $40/hr
4+ years expIndependent Health is a company that values growth, innovation, and collaboration. They are seeking a Senior Compliance Specialist to manage compliance activities related to accreditations and regulatory requirements, ensuring alignment with compliance standards and supporting regulatory audits and submissions.
Non ProfitHealthcareProperty & Casualty InsuranceHealth CareInsurance
No H1B
Responsibilities
Review and interpret program standards, regulations and legislation to understand, document and aid in the development and implementation of processes and documentation necessary for accreditation, certification, registration and/or licensing
Provide subject matter expertise and support to PBD’s associates and leadership team in achieving and maintaining accreditations, certifications, registrations and/or licensure pertaining to Pharmacy Benefit Management
Organize and run cross-functional and inter-departmental project teams performing necessary preparation activities for accreditation, certification, registration and/or licensing submissions, mid-cycle audits and renewals; including but not limited to coordinating and/or assisting in gathering requested information, updating, and reviewing documentation for accuracy and other activities as deemed necessary
Facilitate and coordinate periodic reviews and mock audits and maintain documentation and reporting to ensure PBD is audit ready for accreditation renewals
Assist in establishing new and revising existing documentation, including but not limited to policies and procedures to support accreditations
Monitor and evaluate programs and operations compliance with accreditation standards and any state and/or federal regulatory requirements as necessary
Work with VP and Compliance Officer to coordinate and facilitate program requirements, meetings, note taking and dashboard maintenance for the Quality Management Committee
Facilitate the organizational policy and procedure process to ensure all functional areas are maintaining their documentation per company policies; and facilitate policy committee meetings
Develop and maintain monitoring dashboards and trend reports for Medicare Part D STAR measures
Monitor compliance with accreditations, requirements, policies, and procedures to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance
Coordinate and monitor reporting and progress of remediation efforts for instances of non-compliance, including but not limited to corrective action plans and HIPAA privacy and security events
Qualification
Required
High school diploma or GED required
Four (4) years of compliance, legal, quality monitoring/reporting, or program/process management experience required
Excellent analytical and critical thinking skills, with proven ability to analyze abstract components of legislation, regulations, or accreditation standards for requirements identification
Strong problem solving, time management and organizational skills
Advanced PC and Microsoft Office applications required
Excellent presentation, interpersonal, written, and verbal communication skills
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring
Preferred
Associates degree preferred
Experience working with regulatory and accreditation agencies (e.g. URAC, DOL and CMS) and compliance, quality monitoring/reporting or program management preferred
Experience in the creation or review of policies, procedures, and reports and ability to assess controls needed to meet requirements, render decisions and troubleshoot issues
Benefits
Scorecard incentive
Full range of benefits
Generous paid time off
Company
Independent Health
As one of Western New York's first HMOs, Independent Health covers approximately 355,000 people here and across the country with more than 100 plans, services and products.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-11-18Acquired
Leadership Team
Michael W. Cropp, M.D., M.B.A.
President and CEO
Jim Dunlop Jr.
Executive Vice President and Chief Financial Officer
Recent News
vermontbiz.com
2025-11-19
2025-11-19
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