Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today!
The Pharmacy Audit and Compliance Analyst takes responsibility for duties relating to Payer audits and audit related recoveries, understanding pharmacy audit procedures, elements and findings, and having knowledge of payer audit processes while providing hands on audit assistance, tools and reference material for customers.This position is also responsible for Network risk identification, assessment, reporting and remediation. The role is responsible for oversight of the business’s compliance risk monitoring mechanisms including evaluation, assessment and management.
Location: Remote USA
Hours: Flexible, will need to accomodate clients in PST
Responsibilities:
1. Responsible for tracking, trending and coordinating all incoming Payer audit correspondence including but not limited to: Onsite/Desktop/Invoice audit notifications and discrepancy reports, corrective actions and recoveries;
2. Provide expert audit assistance to customers including: proactive audit prevention tips, pre-audit preparation guidance and support, recommend the means of obtaining, analyzing and evaluating the evidentiary data to support appeal of discrepant claims and assist with coordination of any corrective action(s) taken by a Payer;
3. Conduct enhanced screening of prospect customers seeking Network affiliation using a variety of internal and external resources;
4. Identify high risk accounts via the pharmacy performance analytics system, Central Pay and other resources;
5. Provide expert 340B assistance including: proactive implementation of action plans to correct compliance deficiencies; audit prevention tips; audit preparation guidance and support; recommend the means of obtaining, analyzing and evaluating the evidentiary data to support appeal of discrepant claims and assist with coordination of any corrective action(s) needed;
6. Performs audits or compliance assessments of specific areas and specific products to assure accuracy;
7 Work closely with other departments and shares expertise and assists with training, education, and communication to staff and program participants regarding updates to 340B policies and procedures;
8.Ensure compliance with 340B program requisites, including entity and patient qualifications and ensure consistent processes are followed across all;
9. Responsible for maintaining good working relationships with internal and external partners;
10. Responsible for acquiring knowledge of industry audit trends and compliance requirements;
11. Successfully completes special projects as assigned.
12. Performs related duties as assigned.
Education:
Requires completion of a four-year bachelor’s degree program or equivalent combination of experience and education; normally requires a minimum of four (4) years of experience. Prior pharmacy background required. Strong knowledge of third party billing and experience with private health plans and government programs are required. Experience with pharmacy audits, pharmacy compliance, and risk mitigation a plus. Certified or State Licensed Pharmacy Technician desired.
Skills:
1. Excellent organizational skills
2. Excellent customer service skills
3. Ability to multitask and remain flexible in a fast-paced work environment.
4. Ability to communicate effectively both orally and in writing
5. Exceptional interpersonal abilities
6. Ability to work independently with general direction
7. Strong analytical skills; attention to detail
8. Strong computer skills in order to operate effectively with company systems and programs knowledge of Microsoft office, specifically Access and Excel
What Cencora offers
We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members’ ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit https://www.virtualfairhub.com/cencora
$56,500 - 83,270
*This Salary Range reflects a National Average for this job. The actual range may vary based on your locale. Ranges in Colorado/California/Washington/New York/Hawaii/Vermont/Minnesota/Massachusetts/Illinois State-specific locations may be up to 10% lower than the minimum salary range, and 12% higher than the maximum salary range.
Equal Employment Opportunity
Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.
The company’s continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.
Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email hrsc@cencora.com. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned
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Affiliated Companies:
Affiliated Companies: Value Apothecaries Inc
