Pharmacy Network Auditor

Position Description: • Pharmacy Network Auditor evaluates, reports and monitor’s all aspects pertaining to Pharmacy Network auditing services. • The Pharmacy Network Auditor will conduct desktop and onsite audits for pharmacies within the PerformRx Pharmacy Network in accordance with Federal, State, and Internal Audit standards. • The incumbent will also serve as a subject matter expert within the Company regarding standard monitoring measures, auditing procedures, and best practices. • The auditor will assess the risks in the pharmacy audit assignment, perform appropriate audit procedures; draft and communicate audit findings and observations; and collaborate with pharmacy management to resolve issues in a timely and efficient manner. • The Pharmacy Network Auditor analyzes, claims data for potential investigational FWA breaches of network pharmacies. • After review the auditor shall determine details of fraudulent, erroneous, or abusive billing activity on Real Time Application System and various reports. • The auditor must identify and document fraudulent or erroneous activities determined as a result of their work.

Other Skills: • In-depth knowledge of pharmacy operations • PBM, URAC, NCQA, Medicare (Part D), Medicaid experience, a plus • LTC or Specialty Pharmacy experience • Excellent written and verbal communication skills • Proficient of URAC and CMS network requirements • Proficient of Federal and State level auditing network requirements • Knowledge of standard audit practices • Detail oriented • Excellent written and verbal communication • Ability to analyze, develop, evaluate, write and present work product • Experience with presenting and or training • Proficiency in MS Word and Excel • Current Pharmacy Technician (PTCB) Certification • Certified Fraud Examiner Preferred

All your information will be kept confidential according to EEO guidelines.