Compliance Manager - SelectRx
(2025-10)
- Manages the process for communication of Privacy and HIPAA disclosures and documentation.
- Monitors the Privacy Notices and documentation.
- Manages Complaint investigations and documentation from Regulatory bodies.
- Manages and monitors third party vendor compliance.
- Assist with healthcare policy development and process audits as directed by director of healthcare compliance.
- Manages testing activities related to Healthcare Compliance Work plan.
- Monitors compliance with healthcare specific training (HIPAA, FWA, CMS General Compliance training, Monthly Exclusions). Collaborates with other compliance areas as needed for testing/auditing and monitoring functions.
- Manages the completion of third party assessments.
Compliance Audit Analyst - SelectRx
(2023-03 - 2025-10)
- Monitors and manages Attorney General Complaints, Board of Pharmacy complaints, and carrier complaints. Responds in a timely manner.
- Monitors Federal Register, State Regulations, OIG, CMS guidelines, BULA (Board of Pharmacy regulations) and monthly exclusion reports.
- Monitors third party vendor compliance.
- Participates in internal investigations related to pharmacy compliance.
- Monitors training related to HIPAA, Privacy, FWA, and CMS general Compliance Training.
- Initiates and evaluates audits related to the Compliance Work plan.
- Collaborates with other compliance/quality areas as needed for testing and monitoring functions.
- Manages the process for communication of HIPAA disclosures and OCR documentation.
- Monitors Corrective Action Plans and assists with assessing completion.
- Assists the Director of Compliance with assessments, projects, audits, and other regulatory requirements.
Compliance and Accreditation Specialist - Amber Specialty Pharmacy
(2017-11 - 2023-02)
- Managed the Compliance Program including all day to day business needs such as testing/auditing for fraud waste and abuse, Code of Conduct and Conflict of Interest, exclusion and policy and procedure reviews.
- Monitored Federal Register, OIG, CMS websites and monthly exclusion reports.
- Developed and revised policies and procedures for the general operation of the company to stay current with industry standards and accreditation guidelines.
- Participated in in making decisions for all compliance investigations and or ethical issues.
- Tracked complaints, patient satisfaction, medication errors, shipping errors and HIPAA related items for the QM Program. Developed corrective action plans as necessary.
- Reviewed and submitted all applications and documentation for accreditations maintained by the company.
- Reviewed, analyzed, and finalized 100% of patient HIPAA Privacy Complaints, Prescription Incidents and Patient Complaints /Grievances, pharma contracts, claims, prescriptions, etc.
- Chaired and coordinated the Regulatory Compliance Committee, Compliance Committee, Quality Management Committee, and the Policy Committee meetings.
- Created and managed trainings to educate new hires and existing employees about our Compliance Program.
- Provided marketing support by reviewing regulatory-related materials for newsletters and other promotional strategies.
- Developed tools such as checklists/templates to facilitate data collection in support of accreditation efforts.
- Guided the company through two full accreditations with both URAC and ACHC as well as Digital Pharmacy Accreditation with NABP.
- Developed and implemented accreditation policies and procedures for the organization.
- Completed both scheduled and surprise audits to verify compliance with established procedures.
Compliance Specialist - Superior HealthPlan
(2016-05 - 2017-11)
- Developed a tracking guide to ensure 100% compliance with the state contract requirements and company policies and procedures.
- Updated SharePoint with Managed Care Contract requirements.
- Developed reports and pivot tables from the Business Operations department for distribution to management.
- Served as a backup for all member and provider State Complaints sent to HHSC.
