Mark G. Fulton, CHP, CSCS

Director, PBM Programs & Compliance

716.635.4970 mark.fulton@pbdrx.com Connect with me on Linked

ABOUT

Mark has over 20 years in health care services administration, including 18 in management and 13 in compliance. His tenure has covered a variety of functional areas including claims and member and provider servicing operations, training, quality assurance and compliance.

In his role as Director, PBM Programs & Compliance at Pharmacy Benefit Dimensions (PBD), Mark’s extensive knowledge and experience helps him serve as a subject-matter expert for internal associates on compliance matters related to all state and federal regulations, self-funded administration and audit standards. He also oversees and manages all aspects of training and auditing programs.

Outside of work, Mark’s hobbies include playing volleyball and softball and participating in paint nights. He has a large extended family and he enjoys hosting Thanksgiving dinner, where he feeds between 20-27 people each year. Mark also loves to travel and has visited the Riviera Maya, Mexico, Papagayo, Costa Rica, St. Thomas and St. Martin.

EXPERIENCE

Mark is responsible for ensuring all activities at PBD operate in accordance with federal and state regulations, oversees audits, contractual and certification requirements, as well as corporate ethics and compliance.

In addition, Mark chairs the PBD quality management committee, oversees employer group waiver plan (EGWP) prescription drug plans (PDPs), PBD policies and procedures, quality assurance and associate training.

Mark has been with the Independent Health family of companies since 2009, spending time with Independent Health as well as Nova Healthcare Administrators before joining PBD in 2014. Prior to that, Mark held several positions with a national third-party administrator (TPA), administering self-funded group health plans.

EDUCATION

PROFESSIONAL AFFLIATIONS

CERTIFICATIONS

DUTIES AND RESPONSIBILITIES:

  • PBM Programs Compliance
  • Chair of Quality Management Committee
  • Prescription Drug Plans (PDPs)
  • Employer Group Waiver Plans (EGWPs)
  • Policy and Procedure Process
  • Quality Assurance/Quality Control Program
  • Associate Training Program

“It is my responsibility to help lead our organization to doing the right things for the right reasons and thus ensure we deliver the best possible experience to all of our stakeholders.”

 

Fun Fact:
Mark is a classical musician, who took lessons and played the cello for seven years.