Danielle King

Pharmacy Compliance Manager

Elevance Health

Indianapolis, IN

09.2021 - Current

Developed and implemented policies and procedures to ensure compliance with applicable laws, regulations, standards, and best practices.
Conducted internal audits to identify areas of non-compliance and recommend corrective actions.
Performed research on current industry trends and developments in order to remain up-to-date on best practices.
Assisted with the development of training materials for employees regarding compliance requirements.
Served as a primary contact with regulators during external audit reviews.
Reviewed contracts for accuracy and ensured they meet corporate objectives while adhering to applicable law and regulation.
Facilitated meetings between stakeholders including executive leadership, legal counsel, department heads., to discuss compliance matters.
Ensured effective communication of changes in regulations or policies throughout the organization.
Completed internal and external audits according to established procedures.
Implemented improved strategies for regulatory compliance, control testing and process operations.
Identified processes and policy gaps and devised solutions for and requirements.
Oversaw full audit lifecycle according to organizational protocol, generating progress and closing reports for leadership and clients.
Built positive working relationships with other department managers through effective communication.
Performed pre-and post-payment audits on pharmacy claims to ensure accuracy of reimbursement.
Interpreted rules and regulations related to pharmacy auditing requirements for clients.
Analyzed data from various sources, including state Medicaid programs, to identify potential errors or fraud in pharmacy billing practices.
Ensured compliance with federal guidelines related to the Medicare Part D Prescription Drug Program.
Maintained confidentiality of company information obtained in audit assignments.
Presented audit results to management teams, delivering information in non-technical terms for easy understanding.
Managed and trained team members to enhance audit department performance and increase operational efficiency.
Cross-trained employees, enabling completion of priority tasks during personnel absences.