Pharmacy Benefit Audit Manager

CBIZ•Owings Mills, MD

About The Position

The Pharmacy Benefit Audit Manager works in a team environment on government client pharmacy benefit manager (PBM) audits and audit related consulting engagements to manage the validation of the integrity and accuracy of the administration of pharmacy benefit programs. This includes all aspects of contracted services including pricing adherence, formulary management, performance guarantees, rebate administration, and operational functions of the PBM.

Requirements

Minimum Qualifications: High school diploma or GED
Minimum of 3 years of experience working for a PBM, health plan, pharmacy claims processor, or health claims auditor
Familiarity with pharmacy benefit design contracts and PBM auditing guidelines

Nice To Haves

Bachelor’s degree
Experience managing project oriented deliverables and staff-level employees
Proficient use of applicable software programs, including Microsoft Office suite (Excel, Word, and PowerPoint)
Familiarity with database (SQL) applications is beneficial, with a minimum aptitude to learn basic SQL functions
Strong analytical and problem solving skills
Well organized with a high degree of accuracy and attention to detail
Must be able to manage multiple deadlines and prioritize staff assignments
Very strong verbal and written communication, report and proposal writing, presentation, and business development skills.
Client audit experience desirable
May require occasional overnight travel

Responsibilities

Manage staff responsible for contributing to engagements and assign and review analysts’ deliverables
Coordinate schedules and work assignments of engagement staff
Schedule and hold meetings with clients and their PBMs
Assist in the development of criteria and creation of programs with the program design team used to analyze pharmacy claims data
Review and analyze pharmacy claims data output provided by staff and interpret and qualify results
Work with and review spreadsheet applications to manipulate and format data for ease of use by team members and clients
Interface with multi-disciplinary teams in multiple office locations
Maintain security and confidentiality of all protected health information when analyzing material and ensure documentation is qualified and retained
Ensure documentation is qualified and retained in a centralized tracking application
Deliver high-quality accurate work products to clients within deadlines and contribute to business development and retention initiatives