Job description

Job title

Audit Analyst

Reports to

Manager Audit Services

Date

1/1/2022

FLSA Status

Non-Exempt

Job Summary

This position is responsible for PBM Audits including analyzing claims data to resolve claims issues, identifying claims most likely to be audited, reviewing prescription hardcopies to identify potential gaps in documentation requirements, and preparing pharmacy reports to support the pharmacy in preparing for audit. This position will identify and maintain PBM specific documentation requirements for hardcopy prescriptions and maintain information on PBMs that have requirements that exceed State Pharmacy Law. This position may assist management in tracking/trending pharmacy audit/recovery/appeal statistics.

Essential Job Functions

• Audit preparation and support including analyzing claims data to resolve claims issues, identify claims most likely to be audited, reviewing prescription hardcopies to identify potential gaps in documentation requirements, and preparing pharmacy reports to support the pharmacy in preparing for audit.
• Complete audits for external (MaxCare) clients timely and accurately by following all departmental policies and procedures.
• Follow-up to monitor PBM compliance with state law requirements, including actively monitoring timelines for audit.
• Coordination of technician training requests.
• Maintenance of state/federal law documentation and PBM specific billing requirements.
• Interaction, by phone or onsite in person, with pharmacy clients to facilitate preparation and submission of audit and appeals.
• General audit appeal assistance as directed.
• Perform other duties and projects as required by management.

Minimum Qualifications for Consideration:

• CPhT or National Technician Certification preferred
• HS Graduate, college degree preferred
• Two or more years’ experience as a pharmacy technician in a retail pharmacy environment
• Specialized training
• Specialized accreditation

Knowledge, Skills, and Abilities:

• Excellent verbal and written communication skills.
• Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts.
• Able to effectively manage time and prioritize projects in order to meet established deadlines.
• Demonstrate dependability through good attendance and adherence to timelines and schedules.
• Good follow through on projects and deliverables.
• Good analytical skills.
• Good problem-solving skills.
• Demonstrate resourcefulness and ability to take initiative in development and completion of projects.
• Strong sense of customer service.
• Strong proficiency in pc applications which include: Microsoft Windows, Internet, database, word processing (WORD), spreadsheets (EXCEL), presentation software (POWERPOINT), email (OUTLOOK) and file management skills. Able to learn company-specific applications.
• Knowledge of and experience in the industry with regards to terminology and functions for retail/other pharmacy.
• Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN), etc.
• Knowledge and understanding of how and why pharmacy claims process: i.e. calculation of copayments, pricing hierarchies, etc.

Physical requirements/Working Conditions

• This work is sedentary and requires the following physical activities:
• Sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.
• Frequent lifting (up to 20 pounds of paper supplies or minor office equipment).
• Driving to client locations and other sites as needed.

WORKING CONDITIONS:

• Normal office environment
• Remote if approved

Direct reports

No direct reports

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance
• Work from home

Physical setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
Company follows CDC guidelines regarding COVID-19.

Education:

• High school or equivalent (Required)

Experience:

• Pharmacy technician: 2 years (Required)
• Microsoft Office: 1 year (Required)

License/Certification:

• CPhT (Required)

Work Location: Remote

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