Compliance Specialist
On-siteHuntington Beach, California, United States
Job Summary
Conduct pharmacy licensing, credentialing, and billing compliance by managing applications, renewals, amendments, and ownership changes while maintaining accurate records and coordinating submissions with regulatory bodies. Monitor regulatory deadlines, research evolving state and federal pharmacy regulations, and support internal and third-party audits of claims, authorizations, and billing documentation. Assist with implementing billing compliance controls, tracking corrective actions, and developing policies, procedures, and training initiatives. Partner with Pharmacy Operations, Revenue Cycle, and Credentialing teams to escalate risks and manage compliance dashboards, license expiration dates, and reimbursement trends.
Required Qualifications
- Associate's degree in Healthcare Administration, Business Administration, Compliance, Pharmacy Technology, or related field
- 3+ years of healthcare, pharmacy, compliance, licensing, credentialing, medical billing, or reimbursement experience
- Knowledge of healthcare and pharmacy regulatory requirements
- Strong attention to detail and document management skills
- Excellent organizational and project coordination abilities
- Strong analytical and problem-solving skills
- Ability to research and summarize regulatory requirements and operational procedures
- Effective written and verbal communication
- Ability to manage multiple priorities and deadlines
- Advanced Microsoft Excel, Word, Outlook, and reporting skills
- Must be able to lift up to 15 pounds at times
- Able to travel as needed
Desired Qualifications
- Understanding of medical billing, pharmacy billing, claims processing, prior authorization, and reimbursement practices
- Bachelor's degree in Healthcare Administration, Business, Public Health, Compliance, or related field
- Certified Pharmacy Technician (CPhT) certification
- Experience in specialty pharmacy, behavioral health pharmacy, or multi-state pharmacy operations
- Experience supporting audits, licensing programs, or pharmacy reimbursement activities
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