RxSense
Pharmacy Network Auditor
Boston, Massachusetts, US or Remote US
Sponsorship not specified$74k-$110kDetected 15 days ago
ExcelAuditingResearchLeadershipCommunicationCollaborationPublic SpeakingClaims Management
About the role
- The Pharmacy Network Auditor is responsible for the maintenance and growth of the Pharmacy Network Audit program and processes at RxSense, including all internal pharmacy audits, and working closely with external
- pharmacy contractual compliance, and effectively communicating the program updates in real-time to leadership.
- Pharmacy Network Auditor evaluates, reports and monitors all aspects pertaining to Pharmacy Network Auditing services
Responsibilities
- Assess the risks outlined by audit vendor, perform appropriate audit procedures, and collaborate with pharmacy management to resolve issues in a timely and efficient manner
- Maintain audit documentation, and prepare statistical data for internal stakeholder review and action
- Develops and updates Standard Operating Procedures (SOPs) for audit and FWA Programs
- Collaborates with key stakeholders to support pharmacy network initiatives
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Requirements
- Previous Pharmacy Audit Experience is required, understanding of the processes and industry related guidelines are mandatory
- Strong understanding of the pharmacy claims processing ecosystem
- Strong understanding of pharmacy relationships and NCPDP data extracts
- Proficient knowledge and ability to leverage current reporting tools to identify audit and FWA issues proactively
- Strong understanding of Pharmacy Network Standards and how to manage potential FWA issues via claims data
- Proficient knowledge of URAC and CMS network requirements in addition to Federal and State level auditing network requirements
- Ability to research, analyze and report on audit results and industry trends in FWA
- Detail-oriented, ability to multitask, proactive thinker
- Experience with presenting and or training
- Proficiency in MS Word and Excel
- 5+ years of experience in a Retail Pharmacy setting and/or Pharmacy Benefits Management organization
- Proven ability to work independently and drive results
- Excellent written and verbal communication skills
Skills
- Responsible for leveraging current BI Tools to analyze claims data for potential investigational FWA breaches of network pharmacies
Compensation
- $74,000 - $110,000
Company info
- We are a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits.
- Our technology helps enterprise and partnership clients simplify their businesses and helps consumers save on prescriptions.
- As a leader in SaaS technology for healthcare, we offer innovative solutions with integrated intelligence on a single enterprise platform that connects the pharmacy ecosystem.
- With our expertise and modern, modular platform, our partners use real-time data to transform their business performance and optimize their innovative models in the marketplace.
- The role will also serve as a subject matter expert within the Company regarding standard monitoring measures, auditing procedures, and best practices
Equal opportunity
- RxSense believes that a diverse workforce is a more talented and productive workforce.
- As such, we are an Equal Opportunity and Affirmative Action employer.
- We believe in the strength of the collaboration, creativity and sense of community a diverse workforce brings.
- Neither will qualified applicants be discriminated against on the basis of disability or protected veteran status.
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This listing is sourced directly from RxSense's careers page and normalized into a canonical job model.