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Regulatory and Compliance Analyst Job
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| Employer Name: PORT EWEN RX INC dba PORT EWEN PHARMACY |
SpiderID: 13978646 |
| Location: PORT EWEN, New York |
Date Posted: 4/15/2025 |
| Wage: |
Category: Medical/Health |
| Job Code: |
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Job Description:
Regulatory and Compliance Analyst is needed to perform the following duties:
• Assist Pharmacist in reviewing Center of Medicare & Medicaid service (CMS) prescription data claims as well as from third party insurance providers.
• Assist Pharmacist in business operations including inventory control, medication adherence, drug-utilization review (DUR), medication therapy management (MTM), and Comprehensive medication review (CMR), and price reconciliation.
• Ensure Pharmacy is compliant with all regulatory, legal and statutory requirements set forth by state and federal governments.
• Follow CDC Board (Centre of Disease Control) guidelines and news to update any changes in Immunization methods of practice.
• Making sure biannual licensure renewals and required continuous educations programs specific to retail pharmacy practice. In addition, conspicuous display of all mandated certifications/ license/registrations to the public and on-site visits.
• Assist Pharmacist in developing new methodologies for effective prescription data entry, central claims for immediate retrieval of records.
• Apply initiatives from Department of environmental conservation (DEC) to help retail pharmacies prevent violations and protect public health and the environment.
• Assists in maintain the inventory record of CII, CIII, CIV and CV drugs.
• Draft Policy and Procedure manual for Pharmacy to perform internal audit and to achieve regulatory compliance.
• Record and maintain annual inventory of controlled substances in addition to developing real time inventory check after each dispensing.
• Develop Policy & Procedure for conducting Medication Therapy Management (MTM) sessions and Mirixa health care services to improve medication adherence and improve pharmacy star-rating.
• Implementation of system-wide programs, policies, and procedures to ensure system compliance with applicable federal and state laws and regulations.
• Generated a report file to securely maintain Prescription Drug Monitoring Program (PA PMP) in order to screen potential drug abuse/illegal activity along with automated submission to Pennsylvania Board of Pharmacy & DEA.
• Retrospective data analysis of prescribing patterns of primary care providers.
• Complete annual CMS review and continuous updates for Durable medical equipment (DME) regulations as per Pennsylvania State Board of Pharmacy.
• Develop quality assurance techniques to ensure safe and effective inventory control system.
• To prevent Fraud, Waste and Abuse (FWA) by literature research on dosing codes along with diagnosis codes to substantiate the claims.
• Develop and maintain the standard operating procedures (SOP) for retail pharmacy.
• To make protocols for Dispense as Written (DAW) codes in accordance with state legislature.
• Draft new procedures for preventative action when conducting Medication Therapy management sessions as well as documentation of root cause analysis.
• Strict maintenance of HIPPA regulations and updating in a timely manner, Maintaining Office of Inspector General (OIG) checklist for employees and vendors and reporting any exclusion list.
• Review perspectives monthly in order to meet the FWA requirements of 45 CFR of part 46 regulated by office for Human Research Protections (OHRP)
• Ensuring compliance with new rules, regulations as set forth by the DEA, Centers for Medicaid and Medicare Services, New York state board of pharmacy and other state and Federal laws and regulations.
• Maintain Up to date Standard Operating Procedures (SOP) for handling of prescriptions, filling prescriptions, storage of medications, Refrigerator logs, Daily logs, controlled substance storage.
• Review and assist pharmacists with DEA-106 forms for loss or theft of federal controlled substances.
• Timely review of Unbilled and under-payed prescription claims from Centre of Medicaid and Medicare claims (CMS) and third party payers.
• Working along with Elevate Provider Network regarding the medication reconciliation and identifying potential MTM opportunities by using MTM outcomes.
• Internal auditing of the overrides and the DUR codes used in billing in Prime Rx.
• Maintaining the use of proper HCPCS codes and ICD-10 diagnosis codes used in billing the EMEDNY and EPACES.
• Making sure any and all overpayment will be refunded to the appropriate third-Party plan, Medicaid or CMS program within 60 days as per Affordable Care Act 2010.
• Monitor Food and Drug Administration (FDA) periodically for voluntary medication recall, the most effective way to protect public from defective or detrimental products.
Bachelor Degree is required in Pharmacy or Drug Regulatory Affairs or Pharmaceutical Science.
Job Criteria:
Start Date:
Position Type: Part-Time Permanent
Years of Experience Required:
Education Required: Bachelors
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: PORT EWEN RX INC dba PORT EWEN PHARMACY |
Company Type: Employer |
| Company: PORT EWEN RX INC dba PORT EWEN PHARMACY |
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| City: PORT EWEN |
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| State: New York |
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| Zip: |
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