Senior Pharmacy Audit Analyst

Vital Care Infusion Services • Pittsburgh, PA

1d • Onsite

About The Position

The Senior Pharmacy Audit Analyst is an integral member of the Vital Care Infusion Services team and is responsible for supporting the Vital Care pharmacy network and successfully responding to pharmacy payer audits. This position works closely with the franchise network of pharmacies to support timely and accurate responses to payer claims and desk audits. This position will also be the audit team's lead role and help develop and execute project plans to fulfill these needs accordingly.

Requirements

• Demonstrated analytical, quantitative, and organizational skills, providing the ability to analyze progress, identify trends and anomalies, and recommend needed improvements.
• Solution-oriented and resourceful, demonstrates excellent problem-solving and customer service skills.
• Intermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, and Outlook) required.
• Strong aptitude to learn and adapt to new programs.
• Knowledge of specialty and/or infusion medications and standard dosages.
• Strong knowledge of the practice of pharmacy, including statutory laws, regulations, and methods of filling and filing prescriptions.
• Strong business acumen with the ability to quickly grasp issues and understand strategy and demonstrated the ability to make sound business decisions.
• Demonstrated process and project ownership orientation with the ability to manage priorities and meet time commitments.
• Ability to effectively collaborate and communicate project status with department team and Company leadership.
• Ability to work independently with minimal direction and good decision-making ability.
• Highly skilled communicator in verbal, written, and oral presentation of information.
• Minimum of 3 years of experience in the areas of pharmacy audits.
• 3+ years of pharmacy experience (or equivalent combination of education and experience).

Nice To Haves

• Familiarity with pharmacy dispensing software (e.g., CareTend, CPR+, etc.) is highly desirable.
• Experience in infusion, long-term care, specialty, or mail-order pharmacy is highly desired.

Responsibilities

• Manages and coordinates all phases of pharmacy audits, including the preparation and support of completing pharmacy payer audits, obtaining claim data, reviewing dispensing activities for billing errors, obtaining and reviewing requested documentation, reviewing federal/state/local pharmacy laws, documenting audit results, and coordinating the submission of audit responses with Vital Care pharmacies.
• Serve as a team lead to identify and analyze pharmacy audit project needs in supporting franchises.
• Oversee the management and implementation of projects as identified.
• Manages company initiatives to improve compliance, decrease costs, and grow business related to pharmacy audit services.
• Utilizes CareTend as well as Vital Care’s internally developed systems and reports to accomplish work deliverables.
• Communicates with pharmacies to ensure claims data verification and request claim adjustments from Vital Care’s Revenue Cycle Department as needed, which includes, but is not limited to: (1) Making outbound calls to pharmacies and (2) following up with pharmacies by faxing and emailing related documents.
• Communicates with pharmacy payers, auditors, consultants, etc., to discuss audit requests, responses, and results as needed using various media platforms (i.e., email, phone calls.).
• Prepares appropriate documentation for pharmacy payer audits as appropriate.
• Performs follow-up inspection of claims data based on extrapolations from initial audit results.
• Prepares correspondence to pharmacy providers, requesting documentation to validate detected claim discrepancies.
• Prepares audit outcome documentation for pharmacies.
• Documents audit results within internal systems.
• Follows company protocol for notifying management of potential fraud, waste, and abuse.
• Performs report preparation, participation in special projects, problem resolution, and other activities that support the auditing process.
• Engage in consistent and timely follow-up communications with franchise partners using various media platforms (e.g., email, and Microsoft Teams).
• Develop creative training programs in Vital Care’s Learning Management System (LMS) that will assist with franchise education.
• Represents the organization at national, regional, and local conferences if needed, in focus on pharmacy audits.
• Assess, on an ongoing basis, the effectiveness of training programs and resources.
• Perform other related duties as assigned.

Benefits

• Comprehensive medical, dental, and vision plans
• Flexible spending accounts
• Health savings accounts
• Paid time off
• Personal days
• Company-paid holidays
• Paid Paternal Leave
• Volunteerism Days off
• Company-sponsored basic life insurance
• Long-term disability insurance
• Employee-paid voluntary life insurance
• Employee-paid accident insurance
• Employee-paid critical illness insurance
• Employee-paid short-term disability insurance
• 401(k) matching
• Tuition reimbursement
• Employee assistance programs (mental health, financial, and legal)
• Rewards programs offered by our medical carrier
• Professional development and growth opportunities
• Employee Referral Program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed