Biologics Payer Audit and Accreditation Specialist

🕒 September 16

🤠 Texas – Remote

🤠 Texas – Remote

💵 $79.6k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 15%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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McKesson

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1833

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

McKesson is a diversified healthcare leader specializing in pharmaceutical distribution, medical supplies, and healthcare services. Their solutions facilitate patients' access to life-changing therapies, support efficient operations for pharmacies, health systems, and clinics, and address critical issues such as drug shortages through a resilient supply chain. McKesson provides comprehensive services such as pharmacy management software, consulting, and technology solutions for specialty practices, focusing on improving health outcomes and advancing the pharmaceutical industry. They work closely with biopharma companies to enhance medication access, adherence, and commercialization while supporting oncology and biopharma practices through data-driven insights and real-world evidence.

📋 Description

• Support intake, logging, tracking, research, and timely response of PBM audit requests across Biologics sites • Gather supporting documentation and draft audit responses and appeals • Analyze audit findings and discrepancy trends to identify recurring root causes • Maintain audit trackers, dashboards, and reporting for Operations, Quality, Finance, and Legal stakeholders • Support interpretation and application of state pharmacy audit statutes, PBM provider manual terms, and contractual audit limitations • Recommend workflow and documentation changes that reduce audit exposure and recoupment risk • Support URAC and ACHC accreditation maintenance, renewal submissions, and standards compliance • Perform gap analysis between policies, SOPs, operational practice, and accreditation standards • Coordinate accreditation evidence, performance measure reporting, and RFI responses • Support survey readiness through mock audits, staff readiness materials, documentation review, and corrective-action follow-up • Maintain accreditation repositories, licensure and credentialing records, and version control • Support quality improvement projects, CAPA tracking, and effectiveness monitoring • Coordinate between Payer Audit, Accreditation, Quality, Operations, and Compliance stakeholders • Prepare summaries, reports, and presentation materials for leadership and governance committees • Maintain accurate, traceable, audit-ready documentation • Support staff education and job aids related to audit readiness and accreditation standards • Travel to Biologics sites for survey support, mock audits, and readiness activities

🎯 Requirements

• Degree or equivalent and typically requires 4+ years of relevant experience • 4-year undergraduate college degree preferred • Equivalent combination of education and directly relevant experience will be considered • Certified Pharmacy Technician (CPhT) preferred • 4+ years of combined experience in specialty pharmacy, pharmacy operations, PBM, or pharmacy regulatory and payer compliance • 2+ years of PBM audit management and/or PBM auditor experience, including audit response, appeals, and recoupment defense; OR 2+ years of specialty pharmacy accreditation experience (URAC and/or ACHC), including standards interpretation, evidence submission, and survey support • Working knowledge of pharmacy claims adjudication, claim rejections, and associated resolutions • Demonstrated experience maintaining structured documentation, traceability, and corrective action follow-through • Knowledge of pharmacy systems, pharmacy operations, and pharmacy workflow • Working knowledge of state pharmacy audit statutes and PBM provider manual audit provisions a plus • Experience with accreditation management platforms or document control systems a plus • Experience with pharmacy management systems and reporting/analytics tools such as Power BI and Excel a plus • Community oncology, rare disease, or limited distribution drug experience a plus • Strong documentation, organizational, analytical, problem-solving, and decision-making skills • Proficient in Microsoft Office • Ability to manage multiple workstreams with competing deadlines • Ability to operate in a fast-paced, dynamic, regulated business environment

🏖️ Benefits

• Competitive compensation package • Annual bonus or long-term incentive opportunities may be offered • Work-from-home position • Approximately 15% travel • Equal employment opportunities • Reasonable accommodation for applicants with disabilities