At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Onsite Pharmacy Auditor - Remote (based in Southern California)

Job Description

The Onsite Pharmacy Auditor travels to pharmacy locations and performs pharmacy audits and is responsible for the selection and auditing of claims, educating Prime’s network pharmacies and driving contract compliance, and supporting downstream claim corrections to eliminate potential waste.

To best support business needs, we are seeking candidates who reside in Southern California.

Responsibilities

Evaluate potential pharmacies to include in onsite trips considering such information as claim analytic data, prior audit history, and/or referrals, and submit recommended audit plan to manager for approval; finalize onsite audit plans and schedule trips in accordance to Prime’s travel and expense policy
Analyze pharmacy claims to identify those at the highest risk for error; leverage audit analytics and professional knowledge to identify educational trends and select claims for audit in alignment to department procedures and objectives
Leverage professional pharmacy technician knowledge to validate claim documentation and systems data while onsite to ensure claim was accurately processed in accordance with contractual and regulatory obligations. Educate external pharmacy staff on results of observations of pharmacy practices, proper claim submission and the use of Prime Therapeutics’ Pharmacy Provider Manual at all stages of the audit process
Assist in the development and enhancement of audit tools and processes to effectively identify erroneous claims, non-compliant pharmacy practices or potential pharmacy reimbursements
Track audit activities to support data analysis and reporting efforts within the department Prepare initial audit reports to be sent to the network pharmacies
Other duties as assigned

Education & Experience

Bachelor’s degree in Health Science or equivalent combination of education and related work experience; HS diploma or GED is required

National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
2 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and PBM experience to include:
2 years of work experience in audit or quality assurance
1 year of work experience in customer service or a client facing role

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

Proficiency in MS Word, Excel, and database software
Intermediate skill and understanding of the point of sale and on-line pharmacy claims processing environment
Excellent oral, written and interpersonal communication skills
Self-directed worker with excellent organization and analytical skills
Ability to work effectively with a variety of audiences at all levels of the organization
Ability to maintain confidentiality of highly sensitive information
Professional appearance, demeanor, and conflict resolution skills

Preferred Qualifications

3 years previous audit experience
Previous experience conducting onsite pharmacy audits
Current Registration with State Board of Pharmacy in the state where position is located
Previous PBM experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $28.37 - $45.19 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Learn more about this Employer on their Career Site