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    PA Audit Specialist I - San Diego, United States - MedImpact Healthcare Systems, Inc.

    MedImpact Healthcare Systems, Inc.
    MedImpact Healthcare Systems, Inc. San Diego, United States

    1 week ago

    Default job background
    Full time
    Description

    PA Audit Specialist I

    $39,612 - $51,000 - $62,388

    "Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

    This position is not eligible for Sponsorship.

    MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team

    Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

    At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution

    The Scoop:

    The PA Audit Specialist I assists the PA Audit Team in the successful preparation, planning, execution, and follow up of audits. Additionally, this PA Audit Specialist I serves as a lead for PA audits, supports Formulary Administration audits, adherence to performance guarantees, and provides support for the Health Services Quality Improvement program. This PA Audit Specialist I understands how the PA program works, leads client PA audits, and when not in audits, participates in regular departmental meetings. The PA Audit Specialist I assists PA clients with oversight of the PA program, coordinates follow up to audit findings, monitors corrective action plans, and solves client issues related to audits. This PA Audit Specialist I meets with clients (where designated) to understand their QA and compliance programs and aligns MedImpact processes to synergize with these programs. Reports directly to the Manager, Quality, Audit and PA Client Services.

    What You Get To Do:

  • Serves as a technical subject matter expert for all Part D audits by CMS
  • Can serve as PA audit lead as the primary participant with the PA Audit Pharmacist for the PA & UM department where designated
  • Project manages to ensure departmental goals and initiatives are achieved
  • When not in audits, learns all aspects of the current PA program for assigned clients, MedImpact internal processes, and applicable regulations
  • Understands, and can provide Quality Check (QC) to, PA audit related reports and all supporting documentation through a CRM tool (SalesForce)
  • Communicates any errors/issues discovered and provides suggestions for impact analysis as appropriate
  • Trains staff in PA audit requirements as needed
  • Assists with the development of process improvements for the department that includes reviewing daily processes and providing suggestions to leadership
  • Audits established PA guidelines for CMS required measurements and protocols
  • Researches, analyzes, and recommends QA and QA training programs
  • Assists the PA Audit Team with the initiation, performance in, progression, completion, and follow up of CMS client PA audits and other PA audits as needed
  • Assists Appeals Team, Prior Authorization Team, and Clinical PA Guideline Team, as needed
  • Develops capability to use all MedImpact systems relevant to the position
  • Manages with PA Audit Pharmacist in regard to generation and review of impact analysis PA reports, and other client requests related to PA Audit
  • Manages with PA Audit Pharmacist in regard to collaboration with process owners; and generation and communication to client teams regarding PA related compliance issues (PA Communication Memos)

    • Supervisory Responsibilities

    This job has no supervisory responsibilities.

    Education and/or Experience

    For consideration candidates will need:

  • Bachelor's degree from a four-year college or university
  • Two (2) years of direct experience and/or training; or equivalent combination of education and experience
  • Prior PBM, healthcare, or managed care experience preferred

    • Computer Skills

    To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases

    Certificates, Licenses, Registrations

    Must successfully complete one of the national certification exams OR obtain state licensure (in an ). Maintains a current Pharmacy Technician License and/or CPhT certification without restriction.

    Other Skills and Abilities

    Prior authorization, data analysis, and claims research experience preferred. Analytical skills with Health Informatics experience preferred. Experience in promoting disease management or drug cost management programs preferred.

    Travel

    This position may require travel for those located outside of the geographic location of the audit. Attendance may be required at various local training sessions and/or meetings or travel to a client site.

    The Perks:

  • Medical / Dental / Vision / Wellness Programs
  • Paid Time Off / Company Paid Holidays
  • 401K with Company match
  • Life and Disability Insurance
  • Tuition Reimbursement
  • Employee Referral Bonus

    • This position is eligible for Employee Referral Bonus at Level I

    To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to

    MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers, and consumers of healthcare in the

    Equal Opportunity Employer, Male/Female/Disabilities/Veterans

    OSHA/ADA:

    To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Disclaimer:

    The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

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