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WH
WIN HEALTH RX LLC
Regulatory & Compliance Analyst
Career Insights for Compliance Officer / Analyst
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Based on Texas data
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What they do
A Compliance Officer or Analyst monitors internal compliance with company policies and also company compliance with local, state and federal laws. Reviews company documents, including contracts and marketing materials; communicates with employees and develops training and internal policy materials.
$71,465 / year median in Texas
+6% projected growth
Job Description
We are seeking a detail-oriented and proactive Regulatory & Compliance Analyst to join our team. In this role, you will support the pharmacy's efforts to maintain continuous compliance with federal, state, and local regulations. Your primary responsibilities will include reviewing regulatory updates, assisting with compliance initiatives related to claims, insurance, Medicare/Medicaid, and supporting licensure and policy development. This position offers an excellent opportunity for individuals passionate about healthcare compliance and regulatory affairs to contribute to a compliant and efficient pharmacy operation.
Duties:
Assist the pharmacist in maintaining continuous compliance with new pharmacy regulations and compliance initiatives.- Review updates from CMS, DEA, State board of pharmacy and other agencies.
- Assist with claims, insurance, Medicare/Medicaid, DUR, MTM, CMR and inventory compliance.
- Support licensure renewals, continuing education records and required displays. Develop and maintain pharmacy policies, procedures, standard operating procedures, and internal audit processes .
- Draft, revise, and maintain pharmacy policies and procedures.
- Develop SOPs for prescription handling, storage, controlled substances, inventory, refrigerator logs, and daily operations.
- Develop audit tools and compliance checklists Conduct internal audits of pharmacy claims, prescription billing, coding, and reimbursement activities.
- Review CMS, Medicare, Medicaid, and third-party payer claims.
- Identify unbilled claims, underpayments, billing discrepancies, and incorrect overrides.
- Audit DUR, HCPCS, ICD-10, and DAW codes. Maintain controlled-substance compliance and inventory records.
- Maintain Schedule II-V inventory and dispensing records.
- Conduct annual and perpetual inventory reviews.
- Assist with DEA documentation and prescription-monitoring program requirements. Perform quality assurance, compliance investigations, and corrective and preventive action activities.
- Investigate incidents, complaints, billing issues, and audit findings.
- Conduct root-cause analysis and document findings.
- Develop corrective and preventive action plans and update SOPs. Support medication therapy management, drug-utilization review, medication adherence, and patient-safety initiatives.
- Assist with MTM, CMR, DUR, medication reconciliation, and adherence programs.
- Identify medication-related risks and support pharmacist interventions. Monitor medication recalls, product recalls, inventory reconciliation, and third-party audit requirements .
- Monitor FDA recall notices and safety alerts.
- Identify recalled medications by lot number and reconcile inventory.
- Assist with audit-response documentation and repayment processes. Maintain HIPAA, fraud, waste and abuse, exclusion-screening, and confidential-record compliance processes.
- Support HIPAA compliance and secure record management.
- Assist with employee and vendor exclusion screening.
- Support fraud, waste, and abuse monitoring and documentation.