Client Audit Specialist, PBM

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Manage regulatory and/or client-initiated audits independently or with senior staff and compliance leadership • Review and interpret audit requests to determine scope, impacted business areas, stakeholders, and required evidence • Present sample cases or evidence data and serve as a subject matter expert on business requirements, systems, processes, regulations, and accreditation standards • Develop and maintain internal and external stakeholder relationships to provide audit consultation and streamline work • Monitor audit progress, identify and mitigate risks, escalate issues, and recommend remediation • Perform quality reviews and analyze audit deliverables for contractual and regulatory compliance • Ensure stakeholders understand and complete audit responsibilities accurately and on time • Maintain thorough audit records and prepare deliverables, reports, findings, recommendations, and audit result communications • Lead audit strategy, deliverables, requirements, milestones, and accountability using project management and organizational capabilities • Support department enhancement initiatives and maintain training and procedural materials • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Business, Health Care Services, or related area, or equivalent combination of education and/or relevant work experience • High school diploma from an accredited school or equivalent GED required • 2 years of relevant work experience in audit, compliance, or operations within a regulated environment • Must be eligible to work in the United States without work visa or residency sponsorship • Effective verbal and written communication and presentation skills • Strong interpersonal, meeting facilitation, conflict resolution, consensus-building, and collaboration skills • Critical thinking and analysis skills; ability to navigate ambiguous, complex, and challenging situations • Organization, prioritization, and attention-to-detail skills; ability to manage multiple complex projects under pressure and strict timeframes • Agility and adaptability in a demanding, dynamic, fast-paced, intense, and matrix environment • Independent judgment and critical decision-making ability in analyzing audit processes and evidence • Intermediate to Advanced Microsoft Office Suite skills, including Word and Excel • Preferred: health insurance/PBM operations and/or contract audit experience • Preferred: regulatory compliance experience for Medicare, Medicaid, Commercial, or ACA drug benefits • Preferred: project management experience • Ability to perform essential job functions; reasonable accommodations may be available

🏖️ Benefits

• Benefits, incentives and additional compensation are available; details are provided on the Benefits Page • Equal opportunity and affirmative action employer • Reasonable accommodations for applicants with disabilities • Tobacco-Free Workplace