Pharmacy Audit Analyst
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AI Summary
The Pharmacy Audit Analyst supports the pharmacy network in responding to payer audits by reviewing dispensing activities and coordinating submissions. They act as a liaison between franchise pharmacies and corporate services to ensure accurate claim data and compliance with pharmacy laws.
Recognized as a “Best Place to Work Modern Healthcare” – Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters.
Vital Care (www.vitalcare.com) is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations.
What we offer:
- Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
- Paid time off, personal days, and company-paid holidays.
- Paid Paternal Leave.
- Volunteerism Days off.
- Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
- 401(k) matching and tuition reimbursement.
- Employee assistance programs include mental health, financial and legal.
- Rewards programs offered by our medical carrier.
- Professional development and growth opportunities.
- Employee Referral Program
Job Summary:
The Pharmacy Audit Analyst is responsible for supporting the Vital Care pharmacy network with successfully responding to pharmacy payer audits. This position serves as a liaison between the franchise pharmacy network and Vital Care Infusion Services to support timely and accurate responses to payer claim audits and desk audits.
Duties/Responsibilities:
- Prepares and supports the completion of pharmacy payer audits, including obtaining claim data, reviewing dispensing activities for billing errors, obtaining and reviewing requested documentation, reviewing federal/state/local pharmacy laws, documenting audit results, and coordinating the submission of audit responses with Vital Care pharmacies.
- Utilizes CareTend as well as Vital Care’s internally developed systems and reports to accomplish work deliverables.
- Communicates with pharmacies to ensure claims data verification and request claim adjustments from Vital Care’s Revenue Cycle Department as needed which includes, but not limited to: (1) Making outbound calls to pharmacies and (2) Following-up with pharmacies by faxing and emailing related documents.
- Communicates with pharmacy payers, auditors, consultants, etc. to discuss audit requests, responses, and results as needed using various media platforms (i.e. email, phone calls).
- Prepares appropriate documentation for pharmacy payer audits as appropriate.
- Performs follow-up inspection of claims data based on extrapolations from initial audit results.
- Prepares correspondence to pharmacy providers, requesting documentation to validate detected claim discrepancies.
- Prepares audit outcome documentation for pharmacies.
- Documents audit results within internal systems.
- Follows company protocol for notifying management of potential fraud, waste, and abuse.
- Performs report preparation, participation in special projects, problem resolution and other activities that support the auditing process.
- Engage in consistent and timely follow up communications with franchise partners using various media platforms (i.e. email, Microsoft Teams).
- Develop creative training programs in Vital Care’s Learning Management System (LMS) that will assist with franchise education.
- Assess, on an ongoing basis, the effectiveness training programs and resources.
- Perform other related duties as assigned.
Required Skills/Abilities:
- Strong business acumen with the ability to quickly grasp issues and understand strategy and demonstrated ability to make good business decisions.
- Demonstrated process and project ownership orientation with the ability to manage a range of priorities and meet time commitments.
- Ability to effectively collaborate and communicate project status with department team and Company leadership.
- Ability to work independently with minimal direction and good decision-making ability.
- Highly skilled communicator in verbal, written and oral presentation of information.
- Demonstrated analytical, quantitative, and organizational skills providing the ability to analyze progress, identify trends and anomalies, and recommend needed improvements.
- Solution-oriented and resourceful, demonstrates excellent problem solving and customer service skills.
- Intermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, and Outlook) required. Familiarity with pharmacy dispensing software (e.g. CareTend, CPR+, etc.) highly desirable. Strong aptitude to learn and adapt to new programs.
- Knowledge of specialty and/or infusion medications and standard dosages.
- Strong knowledge of the practice of pharmacy, including statutory laws, regulations, and methods of filling and filing prescriptions.
Education and Experience:
- For consideration candidates will need 3+ years’ pharmacy experience (or equivalent combination of education and experience). Experience in Infusion, Long Term Care, Specialty or Mail Order pharmacy is highly desired.
- Pharmacy audit experience is highly desired.
Physical Requirements:
- Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
- Keyboarding: Frequent use of a keyboard for typing and data entry.
- Reaching: Occasionally reaching for items such as files, documents, or office supplies.
- Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork
- Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.
Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews.
Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status, or any other basis protected by applicable federal, state, or local law.
Vital Care Infusion Services participates in E-Verify.
Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status, or any other basis protected by applicable federal, state, or local law.
Vital Care Infusion Services participates in E-Verify.
This position is full-time and remote. The salary range for this position is $48,972-$65,439.
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