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Auditing Jobs in Philadelphia, PA

Pharmacy Network Auditor

Integrated Resources, Inc

Philadelphia, Pennsylvania

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JOB DETAILS
JOB TYPE
Contractor
SKILLS
Analysis Skills, Auditing, Best Practices, Billing, Content Management Systems (CMS), Data Analysis, Desktop PC, Employee Retention, Medicaid, Medicare, Microsoft Word, National Committee for Quality Assurance (NCQA), Network Performance/Analysis, Network Security, Pharmacy, Presentation/Verbal Skills, Problem Solving Skills, Risk Analysis, Talent Management, Time Management, Utilization Review Accreditation Commission (URAC)
LOCATION
Philadelphia, Pennsylvania
POSTED
2 days ago
Pharmacy Network AuditorIntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.Job DescriptionPharmacy Network Auditor evaluates, reports and monitors all aspects pertaining to Pharmacy Network auditing services. The Pharmacy Network Auditor will conduct desktop and onsite audits for pharmacies. 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.QualificationsIn-depth knowledge of pharmacy operationsPBM, URAC, NCQA, Medicare (Part D), Medicaid experience, a plusLTC or Specialty Pharmacy experienceExcellent written and verbal communication skillsProficient of URAC and CMS network requirementsProficient of Federal and State level auditing network requirementsKnowledge of standard audit practicesDetail orientedExcellent written and verbal communicationAbility to analyze, develop, evaluate, write and present work productExperience with presenting and or trainingProficiency in MS Word and ExcelCurrent Pharmacy Technician (PTCB) CertificationAdditional InformationAll your information will be kept confidential according to EEO guidelines.

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Integrated Resources, Inc

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