Pharmacy Technician Auditor - Express Scripts - Remote

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Requirements:

• 2+ years of pharmacy technician experience in a retail, long term care, specialty, mail order or similar pharmacy setting
• Proficient in database and spreadsheet applications, ie: Microsoft Excel, Access, Word.
• Excellent organizational, interpersonal, and communication skills.
• Ability to work well with all levels of internal and external contacts.
• Ability to handle sensitive or confidential information is critical.
• Ability to work with minimum management oversight while performing on-site audits.
• Ability to work a flexible schedule to accommodate project deadlines.
• Willingness to travel.

Responsibilities:

• Perform efficient and effective network pharmacy claims audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals. Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective assessment of the accuracy and legitimacy of claims audited.
• Utilizing personal knowledge of medications, prescription validity and available tools including the CSP, Access, Excel, Teradata etc., identify pharmacies and claims representing audit risks and develop an audit plan to identify billing discrepancies, to efficiently and effectively address those risks.
• Develop and produce reports as required to meet needs of department management, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues.
• Analyzes and investigates audit findings submitted by auditors to determine validity of identified discrepancies. Analysis includes, pricing, prior authorization, eligibility, plan set-up, financial and performance guarantees, and adherence to state specific laws. Coordinates with cross-functional departments to obtain appropriate resolution to identified issues.
• Discusses the audit with the pharmacy, understanding and managing their expectations and working through any limitations that may be experienced. Tracks status and serves as main contact for pharmacies during all audits
• Prepare for and participate in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed audits, etc., for assigned clients.
• Perform special projects as assigned. Mentor less experienced team members to improve their understanding and skills by ensuring they are familiar with resource materials including manuals and systems. Responsible for the training of new associate auditors on departmental processes.