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Job Description
- Req#: 22-01143
Job Description
Job Title: PBM Auditor
Location: Remote
Duration: 11+ months
Required Experience: 5-6 years of Pharmacy Benefits Management industry experience is mandatory. Need a PBM expert.
The profile should have had experience in the range of 5-6 years in carrying out claims audit/ health plan compliance audits following activities:
Set up a plan summary based on customer plan requirements/ regulatory requirements Analyse the conditions attached to the plans Perform process and data discovery discussions to identify the systems and data points of interest Ability to query and extract necessary information from claims and Rx softwares Conduct analysis and identify exceptions, issues, trends and patterns of interest Audit claims (basis understanding of different types such as co-pay, patient pay, DAW and also different kinds of plans, compounds, formularies, wild card drugs
Overall, their broader range of experiences could include:
Performing complex customer audits in the Pharmacy Benefits Management industry with deep domain expertise across internal workings of the PBM industry, and Med D/EGWP operations/claims adjudication Audits and monitoring activities to ensure compliance with company policies, client contracts, and regulatory guidelines Support Audit activities where there are customer or Medicare requirements for compliance and assess compliance gaps Review business policies, procedures, perform data analysis across multiple source systems to assess compliance to contract and/ health plan requirements Ensure timely completion of audits, recommend measures to continuously build and improve the Audit process Reporting audit results to management and assist with the development of remediation plans as necessary
Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
About the company
We provide Consulting Services for our customer’s project and staffing needs. We also provide Data Management for Clinical Trials.
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