Senior Regulatory Analyst
CurrentConduct regulatory review and analysis of State and Federal laws as they relate to pharmacy benefits specifically and health care privacy laws (HIPAA) generally. This includes Medicare Part D as well as commercial and Health Insurance Marketplace group and individual plans. I work with the customer Contact Center team (Member Services; Pharmacy Help Desk) and also monitor reporting metrics for compliance with CMS call center timeliness and quality measures as well as compliance with commercial and HIM insurance performance guarantees. Also review and update SOPs, job aids, and desktop procedures for operational compliance. Additional responsibilities include overseeing relevant contact-center data for the annual NAIC MCAS report; serving on a Part B implementation project; and overseeing certain CAPs as assigned.