Remote Audit Manager PBM Compliance & Controls

Description

TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care. Did we mention Amazing Care ? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy.

Our team members enjoy:

• A wide range of health insurance options including medical, dental and vision
• A strong salary and bonus program
• A robust 401k and company match
• Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!
• A wellness program including financial incentives, chiropractic and massage services, and fitness stipends
• A cohesive, family-based culture
• Charitable contributions and volunteer time
• Lots of celebrations!

Ok, enough about us. Here’s what we need from you: A future team members' values need to align with TrueScripts' core values of Integrity, Respect, Innovation, and Service. This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a ‘can do, proactive attitude. Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed.

What you’ll do

The Audit Manager is responsible for leading and managing the organization’s audit program, with a primary focus on ensuring TrueScripts is prepared for, compliant with, and responsive to regulatory, client, vendor, and internal audits. This role serves as a central point of accountability for audit readiness, audit execution, evidence management, findings, corrective action plans, and ongoing remediation. The Audit Manager partners closely with Operations, Claims, Client Services, Clinical, IT, Security, Finance, and Compliance to ensure audit requirements are understood, evidence is accurate and complete, and identified risks are addressed timely.

The ideal candidate combines strong audit expertise with an understanding of healthcare, pharmacy benefit management, claims administration, regulatory requirements, and operational processes. This individual must be highly organized, analytical, detail-oriented, and capable of influencing teams without direct authority.

Key Responsibilities:

Audit Program Management

• Develop, maintain, and execute TrueScripts’ comprehensive audit program.
• Establish an annual audit calendar incorporating regulatory, client, vendor, internal, and other required audits.
• Serve as the primary coordinator and point of contact for audits from initiation through final resolution.
• Develop audit plans, timelines, evidence requests, testing approaches, and deliverables.
• Maintain centralized documentation of audit requirements, evidence, findings, responses, and remediation activities.
• Monitor audit deadlines and proactively identify potential risks to successful completion.
• Establish consistent audit processes, standards, templates, and controls across the organization.

Regulatory & Compliance Audits

• Coordinate and manage regulatory and healthcare-related audits, including Market Conduct Audits and other applicable state and federal examinations.
• Partner with Compliance and Legal to interpret audit requirements and ensure appropriate organizational responses.
• Monitor regulatory changes that may create new audit requirements or areas of risk.

Client & External Audits

• Coordinate client audits and information requests while ensuring responses are accurate, complete, timely, and appropriately documented.
• Partner with Client Services and other business leaders to understand contractual audit requirements.
• Establish standardized processes for responding to client audit requests.
• Review audit responses and supporting documentation for completeness and consistency.
• Identify opportunities to reduce the operational burden associated with recurring client audits.

Internal Audits & Risk Assessments

• Evaluate the effectiveness of existing controls and develop and execute internal audits based on organizational risk, regulatory requirements, operational performance, and emerging concerns.
• Conduct process reviews and control assessments across business functions.
• Partner with process owners to develop practical corrective actions.

Audit Findings & Remediation

• Own the centralized tracking of audit findings and corrective action plans.
• Partner with leaders to establish root causes, corrective actions, owners, and target completion dates.
• Monitor remediation progress and escalate overdue or high-risk items and validate implementation of corrective actions.
• Provide leadership with visibility into outstanding risks and remediation efforts.

Claims & PBM Audit Support

• Develop a strong understanding of claims administration, adjudication, pharmacy benefit processes, and related operational controls and partner with internal stakeholders to obtain and validate audit evidence.
• Support audits involving claims configuration, adjudication, pricing, eligibility, benefits, reporting, prior authorization, pharmacy networks, and other PBM functions.
• Identify opportunities to automate recurring audit activities and reduce manual effort.

Audit Readiness & Continuous Improvement

• Develop audit readiness checklists and documentation standards for key business processes.
• Evaluate opportunities to automate evidence collection, testing, reporting, and audit tracking and improve audit workflows
• Partner with Technology and Business Transformation teams to improve audit workflows and reporting.

Leadership Responsibilities

• Lead and develop audit team members as the function grows.
• Establish clear performance expectations, priorities, and accountability.
• Develop team members’ knowledge of PBM operations, regulatory requirements, and audit methodologies.
• Build strong relationships with business leaders and serve as a trusted audit advisor.
• Promote a culture of accountability, transparency, continuous improvement, and risk awareness.

Requirements

• Bachelor’s degree or equivalent demonstrable experience in Accounting, Finance, Business, Healthcare Administration, Compliance, or related field.
• 5+ years of experience in auditing, compliance, healthcare operations, PBM, insurance, or related field.
• Experience managing audits from planning through final resolution.
• Experience with regulatory and client audits, preferably within the healthcare field. Strong understanding of audit methodologies, internal controls, risk assessment, and corrective action processes specific to audits within the healthcare sphere.
• Demonstrated ability to analyze complex operational processes and identify risks and control gaps.
• Strong project management and organizational skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple audits, competing priorities, and tight deadlines.

Work Environment:

This role is a remote job with a flexible “8-5” 40 to 45-hour workweek. All employees of TrueScripts must understand and adhere to Confidentiality and Personal Health Information (PHI) Guidelines as stated in the Employee Handbook.

Physical Demands:

While performing the duties of this job, the employee is frequently required to sit, use hands and fingers and to type for up to eight hours in a workday.