Biologics Payer Audit and Accreditation Specialist

Job not on LinkedIn

🔥 19 hours ago

🤠 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.

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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, and timely response of PBM audit requests across Biologics sites • Research audit findings, gather supporting documentation, and draft audit responses and appeals • Analyze audit findings and discrepancy trends by payer, site, drug, and discrepancy type • 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 • Partner with Operations to recommend workflow and documentation changes that reduce audit exposure and recoupment risk • Support URAC and ACHC accreditation maintenance, renewal application submission, and standards compliance • Assist with gap analysis between policies, SOPs, operational practices, and accreditation standards • Coordinate and upload accreditation evidence, track performance measure reporting, and support RFI response development and submission • Support survey readiness through mock audits, staff readiness materials, documentation review, and corrective-action follow-up • Maintain accreditation documentation repositories, licensure and credentialing records, and version control • Support continuous quality improvement initiatives, 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 development and delivery of staff education and job aids related to audit readiness and accreditation standards

🎯 Requirements

• Degree or equivalent and typically 4+ years of relevant experience • 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 • Specialty pharmacy experience strongly preferred • Working knowledge of state pharmacy audit statutes and PBM provider manual audit provisions a plus • Experience with accreditation management platforms such as AccrediNet or document control systems such as MasterControl 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 • Certified Pharmacy Technician (CPhT) preferred • Ability to effectively manage internal and external stakeholder expectations • Ability to develop collaborative internal and external relationships and partnerships • Detail-oriented with strong documentation and organizational discipline • Ability to communicate effectively with pharmacists, pharmacy staff, operations leaders, auditors, and surveyors • Good problem-solving and decision-making skills • Strong interpersonal and written communication skills • Self-motivated and results-oriented; requires limited direction or direct supervision • Ability to manage multiple workstreams with competing deadlines • Strong analytical skills • Ability to operate in a fast-paced, dynamic, regulated business environment • Proficient in Microsoft Office; technologically savvy • Approximately 15% travel, including travel to Biologics sites • Must be located in Texas, United States, based on the employer-selected posting location

🏖️ 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 job search or employment application