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About the position
As a Pharmacy Network Audit Analyst at Pharmacy Data Management, Inc. (PDMI), you will play a crucial role in the pharmacy network operations, ensuring the accuracy and quality of audits from start to finish. This position involves coordinating and executing detailed audits, identifying potential Fraud, Waste, and Abuse (FWA), and supporting both client services and pharmacy networks. You will be responsible for maintaining high standards in quality assurance, data analysis, and operational reporting, which will have a significant impact on our operations and client satisfaction. In this role, you will take charge of tracking, monitoring, and managing pharmacy and claim audits, ensuring a seamless process from initiation to completion. You will act as the primary contact for clients and pharmacies regarding audit procedures, ensuring clear communication and resolution of any issues that may arise. Your ability to compile and analyze data will be essential in identifying potential FWA and providing actionable insights to prevent future occurrences. Additionally, you will develop and implement quality assurance standards that exceed industry best practices, create and publish policies and procedures for all aspects of pharmacy network audits, and assist in the maintenance and update of pharmacy network information. Your contributions will enhance the overall operations of the pharmacy network and support the company's commitment to improving healthcare quality and efficiency.
Responsibilities
- Take charge of tracking, monitoring, and managing pharmacy and claim audits, ensuring a seamless process from initiation to completion.
- Act as the primary contact for clients and pharmacies regarding audit procedures, ensuring clear communication and resolution.
- Compile and analyze data to identify potential Fraud, Waste, and Abuse (FWA), and provide actionable insights to prevent future occurrences.
- Develop and implement quality assurance standards that exceed industry best practices.
- Create and publish policies and procedures for all aspects of pharmacy network audits.
- Assist in the maintenance and update of pharmacy network information and contribute to the enhancement of MAC operations.
Requirements
- Bachelor's degree in health administration, healthcare analytics, business, or finance. Relevant industry experience may be considered.
- A minimum of three years in a pharmacy analyst role, with experience in auditing, compliance, or as a pharmacy technician being a strong plus.
- Expertise in SQL, Excel, and other database tools, with the ability to develop and analyze complex datasets.
- A meticulous approach to ensuring accuracy and quality in all tasks.
- Strong verbal and written communication skills, with the ability to present data and insights effectively.
- A proactive mindset, capable of resolving issues with creativity and efficiency.
- Exceptional organizational skills, with the ability to manage multiple projects in a fast-paced environment.
Benefits
- Fully remote opportunity with a company that cares.
- Collaborative environment with passionate professionals.
- Opportunities for meaningful work that contributes to improving healthcare quality and efficiency.
- Recognition as a Best Employer in Ohio for the 3rd consecutive year in 2023.
