Pharmacy First is in need of a talented professional to assist the Reconciliation Department by examining and analyzing payer files to identify payer deficits. Additionally, this individual will be proactive in reducing the causes of deficits 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 Analyst will have the opportunity to develop new audit programs and processes as business needs require and will work closely with internal and external partners to conduct audits.
The Compliance Analyst responsibilities include:
- Serve as liaison between the pharmacy and the payer during and/or after an audit
- Communicate with pharmacies regarding necessary requirements of audits
- Develop relationships with 3rd party audit teams to facilitate the sharing of concerns identified by the payer 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 insurance companies 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, 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, additional education preferred
- Knowledge of PBM industries and PBM claims processing systems
- Previous pharmacy experience with preferably at least one year as a Pharmacy Technician
- Pharmacy services background, including knowledge of prescription drugs and specialty products
Serving more than 2,300 independent pharmacies in the U.S. and Puerto Rico, Pharmacy First provides services and support to keep its members competitive in an evolving market. Pharmacy First eases the administrative overhead of independent pharmacy operations by assisting with credentialing, third-party contract management and reconciliation/recovery, quality assurance, medication adherence services and more. For more information, visit pharmacyfirst.com.
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.