Pharmacy Benefit Audit Manager

#LI-MM3

The Pharmacy Benefit Audit Manager works in a team environment on government client pharmacy benefit manager (PBM) audits and audit related consulting engagements to manage the validation of the integrity and accuracy of the administration of pharmacy benefit programs.This includes all aspects of contracted services including pricing adherence, formulary management, performance guarantees, rebate administration, and operational functions of the PBM.

Essential Functions

• Manage staff responsible for contributing to engagements and assign and review analysts’ deliverables
• Coordinate schedules and work assignments of engagement staff
• Schedule and hold meetings with clients and their PBMs
• Assist in the development of criteria and creation of programs with the program design team used to analyze pharmacy claims data
• Review and analyze pharmacy claims data output provided by staff and interpret and qualify results
• Work with and review spreadsheet applications to manipulate and format data for ease of use by team members and clients
• Interface with multi-disciplinary teams in multiple office locations
• Maintain security and confidentiality of all protected health information when analyzing material and ensure documentation is qualified and retained
• Ensure documentation is qualified and retained in a centralized tracking application
• Deliver high-quality accurate work products to clients within deadlines and contribute to business development and retention initiatives

Preferred Qualifications

• Bachelor’s degree
• Experience managing project oriented deliverables and staff-level employees
• Proficient use of applicable software programs, including Microsoft Office suite (Excel, Word, and PowerPoint)
• Familiarity with database (SQL) applications is beneficial, with a minimum aptitude to learn basic SQL functions
• Strong analytical and problem solving skills
• Well organized with a high degree of accuracy and attention to detail
• Must be able to manage multiple deadlines and prioritize staff assignments
• Very strong verbal and written communication, report and proposal writing, presentation, and business development skills.
• Minimum of 3 years of experience working for a PBM, health plan, pharmacy claims processor, or health claims auditor
• Familiarity with pharmacy benefit design contracts and PBM auditing guidelines
• Client audit experience desirable
• May require occasional overnight travel

Minimum Qualifications

• High school diploma or GED