Pharmacy Network Auditor

Job not on LinkedIn

🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $74k - $110k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

RxSense

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

💰 Private Equity Round on 2020-05

Healthcare Insurance • Pharmaceuticals • SaaS

RxSense is a HealthTech company dedicated to modernizing pharmacy benefit management. They develop cutting-edge products that optimize claims adjudication and analysis, aiming to lower costs and improve access within the pharmacy ecosystem. RxSense offers solutions for PBMs, pharmacies, pharma manufacturers, payers, and consumers, supporting better outcomes for millions of people daily. Their products include advanced tools like the RxIQ Enterprise adjudication engine, business intelligence analytics platform, and AI-based pricing optimization. They are known for their flagship prescription savings brand, SingleCare, which helps consumers secure affordable prices while benefiting pharmacy partners.

📋 Description

• The Pharmacy Network Auditor is responsible for the maintenance and growth of the Pharmacy Network Audit program and processes at RxSense • Evaluates, reports and monitors all aspects pertaining to Pharmacy Network Auditing services • Serves as a subject matter expert regarding standard monitoring measures, auditing procedures, and best practices • Assesses risks suggested by audit vendor, performs appropriate audit procedures, and collaborates with pharmacy management for efficient issue resolution • Drafts and communicates audit findings to internal stakeholders; provides Quarterly Network Audit Performance Reports to leadership • Screens and summarizes authorized vendor audit results • Reviews results to identify fraudulent, erroneous, or abusive billing activity • Analyzes claims data for potential investigational FWA breaches of network pharmacies • Maintains audit documentation, and prepares statistical data for review and action • Develops and updates Standard Operating Procedures for audit and FWA Programs • Collaborates with key stakeholders to support pharmacy network initiatives.

🎯 Requirements

• Previous Pharmacy Audit Experience is required, understanding of the processes and industry related guidelines are mandatory • 5+ years of experience in a Retail Pharmacy setting and/or Pharmacy Benefits Management organization • Strong understanding of the pharmacy claims processing ecosystem • Strong understanding of pharmacy relationships and NCPDP data extracts • Proficient knowledge and ability to leverage current reporting tools to identify audit and FWA issues proactively • Strong understanding of Pharmacy Network Standards and how to manage potential FWA issues via claims data • Proficient knowledge of URAC and CMS network requirements in addition to Federal and State level auditing network requirements • Ability to research, analyze and report on audit results and industry trends in FWA • Proven ability to work independently and drive results • Detail-oriented, ability to multitask, proactive thinker • Excellent written and verbal communication skills • Experience with presenting and or training • Proficiency in MS Word and Excel.

🏖️ Benefits

• RxSense believes in the strength of collaboration, creativity and sense of community a diverse workforce brings.