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Years of Experience
Date Last Verified
ProfileCompliance Manager, FEP Duties: Serves as a subject matter expert (SME) for the Federal Employee Program (FEP) Specialty Drug Pharmacy (SDP) Program contract providing compliance and audit support working closely with designated business areas and other internal and external partners. Responsible for leading all FEP audit activity and collaborates with internal stakeholders by providing compliance oversight on the development, implementation, monitoring, issue management and resolution for FEP activities. Additionally, this position conducts research, develops and maintains reporting and dashboards to effectively evaluate the health of Prime’s FEP compliance and audit program. Serve as FEP compliance SME and primary point of contact for internal and external stakeholders; lead FEP audit activities, provide internal consultation and project support regarding FEP compliance oversight, and co-facilitate the issuance, documentation and remediation of Corrective Action Plans (CAPs). Establish an effective FEP audit and compliance oversight program, including the development and oversight of applicable weekly, monthly and ad-hoc management reports; manage, compile and draft reports on FEP audit activity and regularly review dashboards with compliance leadership and other stakeholders to drive strategic action. Manage FEP compliance and audit program; Participate in the implementation and standardization of FEP audit program, Manage annual revision of FEP audit program audit tools, Provide oversight of FEP annual audit plan, and Contribute to the identification of potential solutions to complex issues, Develop, implement, and maintain FEP compliance and audit training solutions. Manage the preparation, implementation, and maintenance of internal FEP compliance and audit standards, protocols, and procedures (SOPs, DTPs, etc); provide support to business areas on related operational SOPs, as appropriate. Monitor overall performance of the FEP audit team including establishing, reviewing and measuring auditing standards, documentation standards, processes and procedures, Ensure processes are followed in accordance with regulatory and contractual requirements and corresponding SOPs. May oversee and support audit action plans and/or corrective action plans for the designated business area; design remedies and support the business in implementing, tracking and completing their plans as required. Represents the compliance organization and at times, Prime, as a primary contact on contracts or significant enterprise projects; collaborates with and represents the interests of key internal and external stakeholders.
Qualification and Experience
Qualifications: Bachelor's Degree in business or healthcare, or JD Degree, or related area of study, or equivalent combination of education and/or relevant work experience. 7 years of progressive legal or compliance related experience for a healthcare or PBM organization, or a combination of 10 years experience working with healthcare claims, Medicare/Medicaid, federal/state government or experience working within a highly regulated industry. Experience in FWA Programs and activities, PBM Operations, Pharmacy Networks, or Pharmacy Audit. Exceptional written and oral communication skills. Demonstrated ability to apply critical thinking skills to proactively identify issues and problem solve through the most complex compliance situations. Experience assessing training requirements and developing, delivering and assessing effective enterprise training programs through a variety of channels. Expert level understanding of effective compliance programs, principles, concepts, practices and standards; full breadth of knowledge around industry best practices. Full breadth of knowledge around industry best practices and challenges and previous experience developing new concepts, techniques, standards and programs to support an organization’s compliance priorities. Ability to effectively interpret and present complex information to a wide variety of audiences. Ability to establish rapport and effectively influence at all levels within an organization. Enhanced organizational skills with the ability to effectively work on multiple projects simultaneously. Ability to read and interpret regulatory requirements. Preferred: PBM/Government Programs health care experience. Advanced Degree. Knowledge of Health Insurance Marketplace / Commercial / Government Programs. Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC). Certified Project Management Professional (PMP)Advanced Degree. Previous leadership experience.