Pharmacy First is in need of a talented professional to assist our Managed Care team by being proactive in reducing the causes of deficits and identifying potential audit targets by utilizing database tools and reports in collaboration with pharmacies and payers. The individual in this role will be responsible for administering these tools, including oversight of the audit process and architecture, conducting pharmacy outreaches in conjunction with other team members, providing audit quality control, and finalizing and summarizing audit results. The Compliance Auditor will work with the Pharmacy Review Committee and have the opportunity to develop new audit programs and processes as business needs require.
The Compliance Auditor responsibilities include:
- Develop educational materials that provide information on PBM guidelines and audit triggers
- Provide pre-audit consultation and assistance and audit preparations
- Serve as liaison between the pharmacy and the PBM during and/or after an audit
- Develop relationships with wholesaler and PBM audit teams to facilitate the sharing of concerns and allow for proactive responses
- Review audit reports and determines potential risk of overpayments/deficits
- Handle incoming calls from retail pharmacies and providers related to audit requests providing problem resolution when necessary in a timely and professional manner
- Research and resolve direct requests from pharmacies related to outstanding payments
- Assist with necessary communications with PBMs to discuss and correct discrepancies
- Identify issues that require additional investigation, evaluation and/or escalation to management; ensure appropriate follow-up with payers and pharmacies
- Attention to detail and willingness to problem-solve to a resolution
- Ability to multi-task and manage multiple projects at once
- Demonstrate effective interpersonal communications with coworkers, senior staff and affiliate pharmacies.
- Effective analytical, oral and written communication and organizational skills
- Systems and software proficiency, including Word, Excel and Access
- High School Diploma or GED required, Bachelor’s degree preferred
- Fraud Examiner certification preferred
- Knowledge of PBM industries and PBM claims processing systems
- In-depth understanding of the types of PBM audits and PBM audit triggers
- Previous pharmacy experience with preferably at least two years as a Pharmacy Technician
- Pharmacy services background, including knowledge of prescription drugs and specialty products
Pharmacy First is dedicated to helping the Independent Pharmacy remain competitive and profitable in today’s market. We offer an array of services, including contracting assistance (PSAO), third-party payer reconciliation, and adherence services to help meet the most important needs of independent pharmacy owners. Our pharmacies are given the freedom to choose which programs best fit their needs. We pride ourselves in making our pharmacy services available to all independent pharmacies, without specific ties to a wholesaler. Join Pharmacy First today and enjoy the benefits of our pharmacy management team!
Pharmacy First’s policy is to provide equal opportunity to all people without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, citizenship status, sex, sexual orientation, gender identity or any other legally protected category. Pharmacy First is proud to be a drug-free workplace.
If interested in the position, please contact Scott Chase, Director of Human Resources, at 913-661-0298 ext. 130 or by e-mail at email@example.com.