Pharmacy Audit and Compliance Analyst

Cencora•USA > PA > Remote, PA

2d•$48,200 - $96,360•Remote

About The Position

The Pharmacy Audit and Compliance Analyst takes responsibility for duties relating to payer audits and audit related recoveries, understanding pharmacy audit procedures, elements and findings, and having knowledge of payer audit processes while providing hands on audit assistance, tools and reference material for customers. This position is also responsible for Network risk identification, assessment, reporting and remediation. The role is responsible for oversight of the business’s compliance risk monitoring mechanisms including evaluation, assessment and management.

Requirements

Requires completion of a four-year bachelor’s degree program or equivalent combination of experience and education; normally requires a minimum of four (4) years of experience.
Prior pharmacy background required.
Strong knowledge of third party billing and experience with private health plans and government programs are required.
Excellent organizational skills
Excellent customer service skills
Ability to multitask and remain flexible in a fast-paced work environment.
Ability to communicate effectively both orally and in writing
Exceptional interpersonal abilities
Ability to work independently with general direction
Strong analytical skills; attention to detail
Strong computer skills in order to operate effectively with company systems and programs knowledge of Microsoft office, specifically Access and Excel

Nice To Haves

Experience with pharmacy audits, pharmacy compliance, and risk mitigation a plus.
Certified or State Licensed Pharmacy Technician desired.

Responsibilities

Responsible for tracking, trending and coordinating all incoming Payer audit correspondence including but not limited to: Onsite/Desktop/Invoice audit notifications and discrepancy reports, corrective actions and recoveries;
Provide expert audit assistance to customers including: proactive audit prevention tips, pre-audit preparation guidance and support, recommend the means of obtaining, analyzing and evaluating the evidentiary data to support appeal of discrepant claims and assist with coordination of any corrective action(s) taken by a Payer;
Conduct enhanced screening of prospect customers seeking Network affiliation using a variety of internal and external resources;
Identify high risk accounts via the pharmacy performance analytics system, Central Pay and other resources;
Work closely with other internal departments such as: Sales, Central Pay, Membership, Legal, CSRA, AR and Credit, in the identification of high risk accounts;
Responsible for maintaining good working relationships with internal and external partners;
Responsible for acquiring knowledge of industry audit trends and compliance requirements;
Successfully completes special projects as assigned.
Performs related duties as assigned.