What are the responsibilities and job description for the Pharmacy Network Auditor position at vTech Solution?
Company Description
vTech can help you avoid the daunting task of writing and posting job offers, shifting through resumes and laboring through the lengthy interview process. Our Staffing solutions will allow you to elude those tasks and place topnotch, high-caliber professionals in the position you need to fill.
We use our expertise, knowledge, and global resources to deliver top-quality candidates and tailor our IT and Non-IT recruitment services to your needs. This allows us to deliver the required results in a timely manner that meets your schedule at a substantially reduced cost.
We pride ourselves for having one of the fastest growth rate and also the lowest turnover rates in the industry just 2.5 percent annually. We focus on the training and retaining qualified professionals with high personal and work ethics. With the help of our extensive database of internal candidates and CATS applicants tracking system, we can provide quality resources within the limited time frame.
We have also successfully placed hundreds of candidates in the areas related to Information Technology, Engineering, professional, Scientific & Clinical, etc. for both our commercial and government clients.
- Source: A recruiter sources candidates from various sources; the search starts from our proprietary database. Using advanced sourcing methods like social media, professional networking media, internal, and 3rd party job boards, we identify qualified candidates.
- Validate: A recruiter validates the candidates’ experience and skill sets against our client’s position.
- Initial Screening: Based on the position and the client’s work culture, the recruiter uses initial screening questions to determine the most suitable candidates.
- Submit: the recruiter will submit to the technical team qualified candidates who have passed the initial screening.
- Technical Screening: The technical team then prepares a matrix of the particular requirements and required experience for the position and using a list of questions and the results, re-validates the candidates’ technical skills.
- Background Check: Administrative personnel will provide a detailed background check, as required, per client agreement.
- On board: On successfully completing the above steps, the candidates are welcomed on board and assisted to ensure a smooth integration at the client’s location.
Job Description
Position Description:
• Pharmacy Network Auditor evaluates, reports and monitor’s all aspects pertaining to Pharmacy Network auditing services.
• The Pharmacy Network Auditor will conduct desktop and onsite audits for pharmacies within the PerformRx Pharmacy Network in accordance with Federal, State, and Internal Audit standards.
• The incumbent will also serve as a subject matter expert within the Company regarding standard monitoring measures, auditing procedures, and best practices.
• The auditor will assess the risks in the pharmacy audit assignment, perform appropriate audit procedures; draft and communicate audit findings and observations; and collaborate with pharmacy management to resolve issues in a timely and efficient manner.
• The Pharmacy Network Auditor analyzes, claims data for potential investigational FWA breaches of network pharmacies.
• After review the auditor shall determine details of fraudulent, erroneous, or abusive billing activity on Real Time Application System and various reports.
• The auditor must identify and document fraudulent or erroneous activities determined as a result of their work.
Other Skills:
• In-depth knowledge of pharmacy operations
• PBM, URAC, NCQA, Medicare (Part D), Medicaid experience, a plus
• LTC or Specialty Pharmacy experience
• Excellent written and verbal communication skills
• Proficient of URAC and CMS network requirements
• Proficient of Federal and State level auditing network requirements
• Knowledge of standard audit practices
• Detail oriented
• Excellent written and verbal communication
• Ability to analyze, develop, evaluate, write and present work product
• Experience with presenting and or training
• Proficiency in MS Word and Excel
• Current Pharmacy Technician (PTCB) Certification
• Certified Fraud Examiner Preferred
Additional Information
All your information will be kept confidential according to EEO guidelines.
