Pharmacy Audit Analyst

Responsibilities

The role of the Pharmacy Audit Analyst is to support audit projects of various types including but not limited to financial guarantees (pricing and rebates), manufacturer contracts, benefit design, pre/post-implementation, and delegation/operational audits. Day to day responsibilities include the following:

• Create project plans and timelines for new audits
• Leverage existing documentation request lists to drive asks for project deliverables
• Schedule and attend audit project kickoff calls
• Audit of pharmacy claims (including test claims) and supporting materials per individual audit scope
• Work directly with the PBM on samples or any questions that arise from audits
• Effectively determine confirmed errors versus those potential findings that are mitigated through further information, discussion, evidence or confirmation of client intent
• Review and assess the validity of PBM response to claim samples, findings and reports
• Draft reports leveraging existing templates and examples
• Negotiate audit findings, making observations and recommendations as necessary
• Track audit status on a regular basis
• Communicate effectively with leaders throughout the organization on audit status and findings

• 3+ years PBM experience in an audit or analytical role
• Undergraduate degree
• Basic knowledge of SQL
• Excellent Written Communications
• Strong attention to detail
• Effective Project Management skills
• Ability to travel 5%

• CPhT
• Level of comfort presenting complex results to project stakeholders