PANTHERx Rare Pharmacy · 1 month ago
Payer Audit Manager
Pittsburgh, PA
Full-time
Hybrid
Mid, Senior Level
4+ years expPANTHERx Rare Pharmacy is the nation’s largest rare disease pharmacy, dedicated to providing the highest quality outcomes for patients. The Payer Audit Manager oversees third-party payer audits, ensuring compliance with contractual and regulatory requirements while managing audit processes and fostering relationships with external auditors.
BiotechnologyHealth CareMedicalPharmaceutical
Responsibilities
Ensures timely and accurate preparation and submission of all audit documentation to meet established deadlines
Tracks and manages all audit timelines and deliverables to guarantee compliance and avoid penalties
Compiles and validates all data required for audits, including pharmacy claim information, REMS program documentation, and other operational records
Conducts a thorough first-level review of audit documentation for completeness and accuracy
Collaborates closely with Pharmacy Operations, Compliance, and other internal teams to gather and verify required information
Prepares for state inspections and accreditation audits as needed
Develops and maintains quality assurance reports related to audit activities
Act as the primary point of contact for third-party auditors, managing communications professionally and effectively
Handles audit appeals, grievances, and reconsideration requests in accordance with payor requirements
Communicates audit trends, issues, and risks to leadership promptly
Creates educational materials, such as audit tips and job aids, to support internal teams
Conducts mock audits and readiness checks to ensure operational preparedness
Builds and maintains strong relationships with external auditors to promote collaboration and minimize friction during audits
Performs additional projects and tasks as assigned
Qualification
Required
Bachelor's degree in healthcare administration, business, or a related field (or equivalent experience)
Strong analytical and organizational skills with proven ability to manage complex data sets
Exceptional attention to detail and ability to work independently under tight deadlines
Excellent communication and relationship management skills
Proficiency in interpreting pharmacy claim data and related documentation
Preferred
Minimum of three (3) years as a practicing, licensed pharmacist or pharmacist technician in a specialty pharmacy
Minimum of three (3) years experience in pharmacy claims billing
Minimum of one (1) year of work experience in an audit or quality assurance environment
Benefits
Medical
Dental
Vision
Health savings and flexible spending accounts
401K with employer matching
Employer-paid life insurance
Short/long term disability coverage
Employee Assistance Program
Generous paid time off
Paid holidays
Company
PANTHERx Rare Pharmacy
PANTHERx Rare Pharmacy is the rare Disease Specialty Pharmacy'', servicing patients nationwide.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2020-12-15Acquired
Leadership Team
Bansi Nagji
Chief Executive Officer
Recent News
Morningstar.com
2026-01-09
2026-01-09
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