Pharmacy Network Auditor

Job Description

DESCRIPTION:

Pharmacy Network Auditor evaluates, reports and monitor’s all aspects pertaining to Pharmacy Network auditing services. The Pharmacy Network Auditor will conduct desktop and onsite audits for pharmacies. The incumbent will also serve as a subject matter expert within the Company regarding standard monitoring measures, auditing procedures, and best practices. The auditor will assess the risks in the pharmacy audit assignment, perform appropriate audit procedures; draft and communicate audit findings and observations; and collaborate with pharmacy management to resolve issues in a timely and efficient manner. The Pharmacy Network Auditor analyzes, claims data for potential investigational FWA breaches of network pharmacies. After review the auditor shall determine details of fraudulent, erroneous, or abusive billing activity on Real Time Application System and various reports. The auditor must identify and document fraudulent or erroneous activities determined as a result of their work.

Qualifications

• In-depth knowledge of pharmacy operations

• PBM, URAC, NCQA, Medicare (Part D) , Medicaid experience, a plus

• LTC or Specialty Pharmacy experience

• Excellent written and verbal communication skills

• Proficient of URAC and CMS network requirements

• Proficient of Federal and State level auditing network requirements

• Knowledge of standard audit practices

• Detail oriented

• Excellent written and verbal communicate

• Ability to analyze, develop, evaluate, write and present work product

• Experience with presenting and or training

• Proficiency in MS Word and Excel

• Current Pharmacy Technician (PTCB) Certification

Additional Information

All your information will be kept confidential according to EEO guidelines.