Specialist, Contracting and Audit

Navitus Health Solutions, LLC

11d•Remote

About The Position

Lumicera Health Services is seeking a Contracting and Audit Specialist to join our team! The Contracting and Audit Specialist will assist with the business needs of the payer relations and contracting team which may include supporting proactive contracting compliance to prepare for and/or mitigate future audits, and respond to requested audits, prescription validations, and audit responses such appeals and requests for additional information. The primary responsibility of this position is to effectively manage all payer program compliance and responding to all payer requests. The Contracting and Audit Specialist will support and report to the Manager, Payer Contracts. The Contracting and Audit Specialist will support the Lumicera and all strategic partners that Lumicera provides shared services for to help meet strategic goals and mitigate financial losses from payers. The Contracting and Audit Specialist will interface with business leaders, pharmacists, legal, compliance, and external vendors with respect to specialty pharmacy services and audit duties. Is this you? Find out more below!

Requirements

High School degree or equivalent required
At least 5 years of pharmacy, payer, audit or similar experience
Experience with Microsoft Excel, Word or equivalent is preferred
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

Bachelor’s degree preferred
Certified Pharmacy Technician preferred

Responsibilities

Complete credentialing and new contract applications for vendors including payer and government clients
Compile supporting documents and reports for payer applications, contracts, business reviews, audits, and ad hoc business requests
Track agreements through the contracting process from reception to completion with both internal and external stakeholder input
Re-enroll and re-credential existing payer and government plans. Monitor to proactively reenroll and resubmit to ensure no gaps in coverage
Coordinate payer access roadmap for expanded payer contracts and investigate current networks where Lumicera and its partner pharmacies are not in network with
Conduct internal testing, sampling, and auditing of operational and documentation processes to ensure compliance
Analyze, compile, and prepare data analytics and presentations for payer clients
Perform analyses and reports required for URAC, ACHC, and other accreditations as required. Assist with accreditation submissions as they pertain to evaluation and reporting
Travel to meet with auditors and regulatory officials to meet audit and appeal standards
Other duties as assigned