Audit Analyst

Job Title: Audit Analyst

Location: Remote

FLSA Status: Non-Exempt

Job Summary

This position is responsible for PBM audits, including analyzing claims data to resolve claims issues, identifying claims most likely to be audited, reviewing prescription hardcopies to identify potential gaps in documentation requirements, and preparing pharmacy reports to support the pharmacy in preparing for audit. This position will identify and maintain PBM-specific documentation requirements for hardcopy prescriptions and maintain information on PBMs that have requirements that exceed State Pharmacy Law. This position may assist management in tracking/trending pharmacy audit/recovery/appeal statistics.

Essential Job Functions

  • Audit preparation and support, including analyzing claims data to resolve claims issues, identifying claims most likely to be audited, reviewing prescription hardcopies to identify potential gaps in documentation requirements, and preparing pharmacy reports to support the pharmacy in preparing for audit.
  • Complete audits for external clients timely and accurately by following all departmental policies and procedures.
  • Follow-up to monitor PBM compliance with state law requirements, including actively monitoring timelines for audit.
  • Coordination of technician training requests
  • Maintenance of state/federal law documentation and PBM-specific billing requirements.
  • Interaction by phone or onsite in person with pharmacy clients to facilitate preparation and submission of audit and appeals.
  • General audit appeal assistance as directed.
  • Perform other duties and projects as required by management.

Minimum Qualifications

  • CPhT or National Technician Certification required.
  • High school graduate; college degree preferred.
  • Two or more years’ experience as a pharmacy technician in a retail/community pharmacy environment.
  • PBM experience a plus.

Additional Responsibilities

  • Other duties as assigned or required.

Knowledge, Skills & Abilities

  • Excellent verbal and written communication skills.
  • Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts.
  • Able to effectively manage time and prioritize projects in order to meet established deadlines.
  • Demonstrate dependability through good attendance and adherence to timelines and schedules.
  • Good follow-through on projects and deliverables.
  • Good analytical skills.
  • Good problem-solving skills.
  • Demonstrate resourcefulness and ability to take initiative in development and completion of projects.
  • Strong sense of customer service.
  • Strong proficiency in PC applications, including: Microsoft Windows, Internet, database, word processing (WORD), spreadsheets (EXCEL), presentation software (POWERPOINT), email (OUTLOOK) and file management skills; able to learn company-specific applications.
  • Knowledge of and experience in the industry with regards to terminology and functions for retail/other pharmacy.
  • Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN), etc.
  • Knowledge and understanding of how and why pharmacy claims process; i.e., calculation of copayments, pricing hierarchies, etc.

Physical Requirements/Working Conditions

  • Sedentary work, requiring the following physical activities: sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.
  • Frequent lifting (up to 20 pounds of paper supplies or minor office equipment).
  • Travel to client locations and other sites as needed.

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.

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Audit Analyst