Pharmacy Network Auditor

divh2Pharmacy Network Auditor/h2pIntegrated 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./ph3Job Description/h3pPharmacy 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./ph3Qualifications/h3ulliIn-depth knowledge of pharmacy operations/liliPBM, URAC, NCQA, Medicare (Part D), Medicaid experience, a plus/liliLTC or Specialty Pharmacy experience/liliExcellent written and verbal communication skills/liliProficient of URAC and CMS network requirements/liliProficient of Federal and State level auditing network requirements/liliKnowledge of standard audit practices/liliDetail oriented/liliExcellent written and verbal communication/liliAbility to analyze, develop, evaluate, write and present work product/liliExperience with presenting and or training/liliProficiency in MS Word and Excel/liliCurrent Pharmacy Technician (PTCB) Certification/li/ulh3Additional Information/h3pAll your information will be kept confidential according to EEO guidelines./p/div

Careers Integrated Resources Inc