Pharmacy Network Auditor

IntegratedResourcesINC

Philadelphia, PA, United States contract

Posted: August 17, 2017

Required Skills

Job Description

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

DESCRIPTION:

Pharmacy Network Auditor evaluates, reports and monitor’s all aspects pertaining to Pharmacy Network auditing services. The Pharmacy Network Auditor will conduct desktop and onsite audits for pharmacies. The incumbent will also serve as a subject matter expert within the Company regarding standard monitoring measures, auditing procedures, and best practices. The auditor will assess the risks in the pharmacy audit assignment, perform appropriate audit procedures; draft and communicate audit findings and observations; and collaborate with pharmacy management to resolve issues in a timely and efficient manner. The Pharmacy Network Auditor analyzes, claims data for potential investigational FWA breaches of network pharmacies. After review the auditor shall determine details of fraudulent, erroneous, or abusive billing activity on Real Time Application System and various reports. The auditor must identify and document fraudulent or erroneous activities determined as a result of their work.

• In-depth knowledge of pharmacy operations

• PBM, URAC, NCQA, Medicare (Part D) , Medicaid experience, a plus

• LTC or Specialty Pharmacy experience

• Excellent written and verbal communication skills

• Proficient of URAC and CMS network requirements

• Proficient of Federal and State level auditing network requirements

• Knowledge of standard audit practices

• Detail oriented

• Excellent written and verbal communicate

• Ability to analyze, develop, evaluate, write and present work product

• Experience with presenting and or training

• Proficiency in MS Word and Excel

• Current Pharmacy Technician (PTCB) Certification

All your information will be kept confidential according to EEO guidelines.

Why Apply Through MisuJob?

AI-Powered Job Matching: MisuJob uses advanced artificial intelligence to analyze your skills, experience, and career goals. Our matching algorithm compares your profile against thousands of job requirements to find positions where you have the highest chance of success. This saves you hours of manual job searching and ensures you only see relevant opportunities.

One-Click Applications: Once you create your profile, applying to jobs is effortless. Your resume and cover letter are automatically tailored to highlight the most relevant experience for each position. You can apply to multiple jobs in minutes, not hours.

Career Intelligence: Beyond job matching, MisuJob provides valuable career insights. See how your skills compare to market demands, identify skill gaps to address, and understand salary benchmarks for your experience level. Make data-driven decisions about your career path.

Frequently Asked Questions

How do I apply for this position?

Click the "Register to Apply" button above to create a free MisuJob account. Once registered, you can apply with one click and track your application status in your dashboard.

Is MisuJob free for job seekers?

Yes, MisuJob is completely free for job seekers. Create your profile, get matched with jobs, and apply without any cost. We help you find your dream job without any hidden fees.

How does AI matching work?

Our AI analyzes your resume, skills, and experience to understand your professional profile. It then compares this against job requirements using natural language processing to calculate a match percentage. Higher matches mean better fit for the role.

Can I apply to jobs in other countries?

Absolutely. MisuJob features jobs from companies worldwide, including remote positions. Filter by location or look for remote opportunities to find jobs that match your preferences.

Ready to Apply?

Join thousands of job seekers using MisuJob's AI to find and apply to their dream jobs automatically.