AllergyMoms LLC · 1 day ago
Pharmacy Audit Analyst
United States
Full-time
Remote
Mid Level
3+ years expAllergyMoms LLC is a premier pharmacy franchise business committed to improving the lives of patients and healthcare professionals. The Pharmacy Audit Analyst will support the pharmacy network by responding to payer audits, ensuring accurate claims data verification, and preparing necessary documentation for audits.
Health Wellness & Fitness
Responsibilities
Prepares and supports the completion of pharmacy payer audits, including obtaining claim data, reviewing dispensing activities for billing errors, obtaining and reviewing requested documentation, reviewing federal/state/local pharmacy laws, documenting audit results, and coordinating the submission of audit responses with Vital Care pharmacies
Utilizes CareTend as well as Vital Care’s internally developed systems and reports to accomplish work deliverables
Communicates with pharmacies to ensure claims data verification and request claim adjustments from Vital Care’s Revenue Cycle Department as needed which includes, but not limited to: (1) Making outbound calls to pharmacies and (2) Following-up with pharmacies by faxing and emailing related documents
Communicates with pharmacy payers, auditors, consultants, etc. to discuss audit requests, responses, and results as needed using various media platforms (i.e. email, phone calls)
Prepares appropriate documentation for pharmacy payer audits as appropriate
Performs follow-up inspection of claims data based on extrapolations from initial audit results
Prepares correspondence to pharmacy providers, requesting documentation to validate detected claim discrepancies
Prepares audit outcome documentation for pharmacies
Documents audit results within internal systems
Follows company protocol for notifying management of potential fraud, waste, and abuse
Performs report preparation, participation in special projects, problem resolution and other activities that support the auditing process
Engage in consistent and timely follow up communications with franchise partners using various media platforms (i.e. email, Microsoft Teams)
Develop creative training programs in Vital Care’s Learning Management System (LMS) that will assist with franchise education
Assess, on an ongoing basis, the effectiveness training programs and resources
Perform other related duties as assigned
Qualification
Required
Strong business acumen with the ability to quickly grasp issues and understand strategy and demonstrated ability to make good business decisions
Demonstrated process and project ownership orientation with the ability to manage a range of priorities and meet time commitments
Ability to effectively collaborate and communicate project status with department team and Company leadership
Ability to work independently with minimal direction and good decision-making ability
Highly skilled communicator in verbal, written and oral presentation of information
Demonstrated analytical, quantitative, and organizational skills providing the ability to analyze progress, identify trends and anomalies, and recommend needed improvements
Solution-oriented and resourceful, demonstrates excellent problem solving and customer service skills
Intermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, and Outlook) required
Knowledge of specialty and/or infusion medications and standard dosages
Strong knowledge of the practice of pharmacy, including statutory laws, regulations, and methods of filling and filing prescriptions
3+ years' pharmacy experience (or equivalent combination of education and experience)
Preferred
Familiarity with pharmacy dispensing software (e.g. CareTend, CPR+, etc.) highly desirable
Experience in Infusion, Long Term Care, Specialty or Mail Order pharmacy is highly desired
Pharmacy audit experience is highly desired
Benefits
Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
Paid time off, personal days, and company-paid holidays.
Paid Paternal Leave.
Volunteerism Days off.
Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
401(k) matching and tuition reimbursement.
Employee assistance programs include mental health, financial and legal.
Rewards programs offered by our medical carrier.
Professional development and growth opportunities.
Employee Referral Program
Company
AllergyMoms LLC
The AllergyMoms website provides support for parents of kids with food allergies.
0-1 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase