Pharmacy Specialist
About The Position
Pharmacy Specialist - REMOTE The Pharmacy Specialist will perform in-depth evaluation and analysis of potential pharmaceutical fraud, waste, or abuse investigations and requests for information using claims information, medical records, and other sources of data. Provide subject matter expertise and technical assistance on matters related to pharmaceutical billing to Medicare and Medicaid. Support the Data Analysis, Program Integrity, Medical Review, and Law Enforcement Coordination teams by consultation with staff and by participating in investigative and/or data analysis efforts. Provide assistance in developing proactive data analysis. In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. This position will report directly to the Medical Director and will work in our Grove City, OH office, or if not local, remotely from a home office.
Requirements
- Must maintain licensure as a pharmacist
- Highly proficient with Microsoft Excel and Word
- Working knowledge of Microsoft Access and PowerPoint, high proficiency with Access is a plus.
- Excellent verbal and written communication skills
- Excellent research skills including internet research
- Ability to work independently with minimal supervision
- Ability to perform multiple priority tasks
Nice To Haves
- A Doctor of Pharmacy is preferred.
- Demonstrated experience analyzing large data sets and producing reports is preferred
Responsibilities
- Assist the Data Analysis, Program Integrity, Medical Review and Law Enforcement Coordination Team Managers and Supervisors by researching Medicare and Medicaid pharmaceutical drug coverage criteria, regulations and policies as requested
- Proactively seek out and develop Medicare and Medicaid pharmaceutical fraud or abuse leads from various sources including CMS, state Medicaid agencies, law enforcement, fraud alerts, or other sources
- Maintain current knowledge of Medicare and Medicaid fraud/abuse issues or vulnerabilities related to pharmaceuticals and recommend appropriate proactive analysis
- Assist the Data Analysis team in developing proactive or reactive data analysis for pharmaceutical related issues
- Assist the Program Integrity team in investigations related to pharmaceutical claims
- Assist the Medical Review team in the review of pharmaceutical claims
- Develop and conduct internal and external training as assigned by management. Assist with training for internal and external stakeholders.
- Provide expert witness testimony as required
- Travel as required for meetings or training
- Perform other duties as assigned
Benefits
- Medical, Dental, Vision plans
- Life, LTD and STD paid by the employer
- 401(k) with company match up to 4%
- Paid Time Off and company paid holidays
- Tuition assistance after 1 year of service
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
