- Review and understand PBM contracts for all relevant pricing terms
- Review and understand plan design documents provided by PBM or client
- Utilize company's proprietary Compliance Model
- Calculate client contractual financial guarantees, admin fees, rebates and other terms as required by client contract
- Assemble audit reports and summarize findings
- Document all potential issues and track decisions
- Collaborate with account management and pharmacy consultants to discuss results with clients and vendors
- Provide documentation during follow-up negotiations and discussions
- Work with IT to further develop Compliance Model logic and capabilities
- Assist in other financial projects as needed
- Bachelor's degree in Business, Finance, or other health related field
- At least 3 years of either a) pharmacy benefit audit or b) claim adjudication research experience on one or more PBM platforms
- Working knowledge of the PBM industry and pharmacy benefit claims
- Proficient in Microsoft Office, with extensive experience working with Excel
- Basic SQL query building
- Strong verbal and written communication skills
- Detail-oriented
- Solid, independent worker (this position will likely be based in the applicant's home)
- Pharmacy Technician Certification (preferred)
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Pharmacy Benefit Audit Analyst - Doral, United States - Secure Eclaims LLC
Description
Job DescriptionJob Description
Specific job functions include:
Requirements:
Desired Skills:
Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substantial millions of dollars savings that keep the cost of healthcare down.
We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology.
Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.
Company DescriptionLeading specialty benefits management company in Puerto Rico and South Florida.
Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substantial millions of dollars savings that keep the cost of healthcare down.
\r\rWe are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology.Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.
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