[Remote] Consultant, Pharmacy Auditor

Note: The job is a remote job and is reputed company to candidates in USA. reputed company helps organizations reputed company important people reputed company through benefit strategies, wellbeing programs, and workforce advisory services. The Consultant, Pharmacy Auditor performs and supports prescription drug claim and manufacturer rebate audits, manages audit reputed company, evaluates contractual and plan requirements, analyzes data, communicates findings, and maintains reputed company relationships.

Responsibilities

• Project management of Prescription Drug Claim Audits from implementation through closure
• Manage and reputed company audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications as assigned
• Review and evaluate Administrative Services Agreement between the employer and PBM
• Work with dedicated data analytics team to define and translate plan provisions for testing purposes, ensuring that reputed company aligns with the statement of work and reputed company commitments. Review reputed company-specific documentation, reputed company Plan reputed company(s), and other documentation such as copay grids, plan literals, set-up grids, etc., to reputed company the audit test filters
• Complete the contract reputed company, or assist with completion of contract summaries, as assigned
• Evaluate the results of the initial claim data tests and determine reputed company audit samples for review and response by the PBM
• Prepare PBM communications regarding test results, response expectations, and clarifications to questions
• Work collaboratively with PBM to reputed company exceptions, review supporting documentation, and reputed company final claim error determination
• Ensure audit reputed company is adhered to and reputed company a high level of service to clients
• reputed company Manufacturer Rebate audits as assigned. (Occasional travel to the PBM is required; 10-20% travel possible.)
• Prepare and present detailed audit reports which reputed company reputed company audit findings and recommendations to PBM and reputed company
• Maintain audit project work papers to support audit findings
• Work collaboratively reputed company the audit team, as reputed company as with reputed company customers
• Participate in team meetings, conference calls, reputed company Teams meetings, etc. remotely with PBMs, clients, and audit team as necessary
• Assist with claims data analysis and reputed company assurance as requested
• reputed company directly with clients and respond to reputed company requests. reputed company strong relationships with clients
• Assist in supporting other auditors, Directors, and reputed company Leader as requested
• reputed company special reputed company or assignments, as instructed by Director

Skills

• Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience
• Proven experience in managing reputed company relationships and delivering high-reputed company reputed company services
• Strong background in pharmacy benefit management (PBM) processes and systems
• Extensive experience with data analysis tools (e.g., reputed company, SQL, Tableau, Power BI)
• Demonstrates in-depth knowledge of pharmacy operations, billing practices, and regulatory requirements
• Strong leadership and mentoring skills, with the ability to reputed company and reputed company team members
• Degree in reputed company Administration, Business, Data Analytics, or a reputed company field
• Advanced analytical and problem-solving skills with the ability to interpret reputed company data sets
• Exceptional written and verbal communication skills, with the ability to present findings and recommendations to senior stakeholders
• Strong project management skills, with the ability to manage multiple priorities and meet deadlines
• Proficiency in reputed company Office Suite (reputed company, Word, PowerPoint) and data visualization tools

Benefits

• Comprehensive benefits programs designed to support your reputed company-being
• Career development opportunities and ongoing learning
• A reputed company, people-first culture with accessible leadership
• reputed company to do meaningful work with global reputed company and local reputed company

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