Pharmacy Network Auditor

Integrated Resources, IncPhiladelphia, PA

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Overview

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On-site

Job Description

Pharmacy Network AuditorIntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.Job DescriptionPharmacy Network Auditor evaluates, reports and monitors 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.QualificationsIn-depth knowledge of pharmacy operationsPBM, URAC, NCQA, Medicare (Part D), Medicaid experience, a plusLTC 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 ExcelCurrent Pharmacy Technician (PTCB) CertificationAdditional InformationAll your information will be kept confidential according to EEO guidelines.

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This job at Integrated Resources, Inc is located in Philadelphia, PA, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.

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