Pharmacy Claims Auditor Sr
New
P
Prime TherapeuticsPharmacy Benefit Management
United StatesFull-TimeSenior
Salary59,000 - 94,000 USD per year
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Job Details
- Experience
- 5 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and Pharmacy Benefit Management experience to include 3 years of work experience in audit or quality assurance
- Required Skills
- Data AnalysisMicrosoft ExcelQuality Assurance
Requirements
- Bachelor's degree in Health Science or related area, or equivalent combination of education and experience.
- 5 years of work experience in pharmacy settings (retail, long term care, specialty, home infusion, or mail order) or PBM experience.
- 3 years of work experience in audit or quality assurance.
- National Pharmacy Technician Certification (PTCB or ExCPT/CPhT).
- Understanding of point of sale and on-line pharmacy claims processing environment.
- Proficiency in MS Word, Excel, and database software.
- Ability to adjust direction based on changing business needs with a high degree of autonomy.
- Critical thinking and problem-solving skills for risk assessment.
- Effective communication and cross-functional collaboration skills.
- Ability to de-escalate confrontational situations.
Responsibilities
- Collaborate with cross-functional teams to identify, develop, deliver, and support training focused on trend analysis, audit planning, procedures, and system process.
- Identify technology enhancement opportunities.
- Provide guidance and operational support to the Pharmacy Audit Operations team.
- Promote best practices, lead projects, and resolve issues.
- Analyze claim and audit data to support ongoing audit analytic efforts and identify trends.
- Collaborate with department staff to create enhanced reporting.
- Represent the audit team as the Subject Matter Expert (SME) for system enhancement initiatives and testing.
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