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Job Posting Title
340B Onsite Pharmacy Auditor - Remote in the Florida market
The Onsite Pharmacy Auditor travels to pharmacy locations and performs pharmacy audits and is responsible for the selection and auditing of claims, educating Prime's network pharmacies and driving contract compliance, and supporting downstream claim corrections to eliminate potential waste.
Responsibilities
Evaluate potential pharmacies to include in onsite trips considering such information as claim analytic data, prior audit history, and/or referrals, and submit recommended audit plan to manager for approval; finalize onsite audit plans and schedule trips in accordance to Prime's travel and expense policy
Analyze pharmacy claims to identify those at the highest risk for error; leverage audit analytics and professional knowledge to identify educational trends and select claims for audit in alignment to department procedures and objectives
Leverage professional pharmacy technician knowledge to validate claim documentation and systems data while onsite to ensure claim was accurately processed in accordance with contractual and regulatory obligations. Educate external pharmacy staff on results of observations of pharmacy practices, proper claim submission and the use of Prime Therapeutics' Pharmacy Provider Manual at all stages of the audit process
Assist in the development and enhancement of audit tools and processes to effectively identify erroneous claims, non-compliant pharmacy practices or potential pharmacy reimbursements
Track audit activities to support data analysis and reporting efforts within the department Prepare initial audit reports to be sent to the network pharmacies
Other duties as assigned
Minimum Qualifications
Bachelor's degree in Health Science or equivalent combination of education and related work experience; HS diploma or GED is required
National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
2 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and PBM experience to include:
2 years of work experience in audit or quality assurance
1 year of work experience in customer service or a client facing role
Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
Proficiency in MS Word, Excel, and database software
Intermediate skill and understanding of the point of sale and on-line pharmacy claims processing environment
Excellent oral, written and interpersonal communication skills
Self-directed worker with excellent organization and analytical skills
Ability to work effectively with a variety of audiences at all levels of the organization
Ability to maintain confidentiality of highly sensitive information
Professional appearance, demeanor, and conflict resolution skills
Preferred Qualifications
3 years previous audit experience
Previous experience conducting onsite pharmacy audits
Current Registration with State Board of Pharmacy in the state where position is located
Previous PBM experience
Minimum Physical Job Requirements
Ability to travel up to 50% of the time
Ability to work a flexible schedule including weekends, holidays, or shifts outside of Prime's core business hours of 9:00am-4:00pm
Frequently required to sit, use hands to handle or feel, talk and hear
Frequently required to stand, use hands to handle or feel, talk and hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and crouch
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
- Reports to a Manager in the Pharmacy Audit and FWA department
Potential pay for this position ranges from $57,600.00 - $86,800.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (***/careers/benefits/) and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.
Positions will be posted for a minimum of five consecutive workdays.
Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.*** or email ***.