Pharmacy Network Auditor
Position 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 within the PerformRx Pharmacy Network in accordance with Federal, State, and Internal Audit standards.
• 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.
Other Skills:
• 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 communication
• 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
• Certified Fraud Examiner Preferred
Additional Information
All your information will be kept confidential according to EEO guidelines.