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Senior Pharmacy Consultant

2 months ago

Richmond, Virginia, United States Gallagher Full time
About the Role

Gallagher is seeking a highly skilled Pharmacy Audit Specialist to join our team. As a key member of our Pharmacy Audit Team, you will be responsible for performing and supporting Prescription Drug Claim Audits to ensure compliance with contractual, regulatory, and custom plan guidelines.

Key Responsibilities
  • Project management of Prescription Drug Claim Audits from implementation through closure.
  • Manage and perform audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications.
  • Review and evaluate Administrative Services Agreements between employers and Pharmacy Benefit Managers.
  • Work with our data analytics team to define and translate plan provisions for testing purposes.
  • Complete contract summaries and assist with the completion of contract summaries as assigned.
  • Evaluate the results of initial claim data tests and determine valid audit samples for review and response.
  • Prepare Pharmacy Benefit Manager communications regarding test results, response expectations, and clarifications to questions.
  • Work collaboratively with Pharmacy Benefit Managers to resolve exceptions, review supporting documentation, and make final claim error determinations.
  • Ensure audit timelines are adhered to and deliver a high level of service to clients.
  • Perform Prescription Drug Claim Rebate audits as assigned.
  • Prepare and present detailed audit reports that clearly articulate audit findings and recommendations.
  • Maintain audit project work papers to support audit findings.
  • Work collaboratively within the audit team and with internal and external customers.
  • Participate in team meetings, conference calls, and Microsoft Teams meetings as necessary.
  • Assist with claims data analysis and quality assurance as requested.
  • Interact directly with clients and respond to client requests.
  • Develop strong relationships with clients.
  • Assist in supporting other auditors, Manager, Director, and Practice Leader as requested.
  • Perform special projects or assignments as instructed by Manager.
  • Attain billable hours objectives.
About You

We are looking for a highly skilled and experienced Pharmacy Audit Specialist to join our team. To be successful in this role, you will need:

  • A college degree (experience may be considered to waive the degree requirement).
  • 10+ years of experience in pharmacy auditing, consulting, or other applicable pharmacy industry experience.
  • Previous Pharmacy Benefit Manager experience is a plus but not required.
  • A high level of pharmacy benefit, claim, or benefit administration knowledge, including Medicare benefits experience.
  • Proficiency in the use of Microsoft Office Suite of programs.
  • Excellent oral and written communication skills.
  • Excellent organizational and time management skills.
  • A personable communication style, positive outlook, leadership skills, and self-confidence.
  • The ability to multi-task and acclimate to changing priorities without losing focus.
  • Attention to detail and the ability to clearly explain thought process in reaching documented conclusions.
  • Self-directed individuals who require little supervision and can manage multiple projects effectively to ensure deadlines are met.
  • A team player with a strong work ethic.
Compensation and Benefits

Gallagher offers a competitive salary, great teams, and exciting career opportunities, as well as a wide range of benefits. Our minimum core benefits include:

  • Medical/dental/vision plans, which start from day one.
  • Life and accident insurance.
  • 401(K) and Roth options.
  • Tax-advantaged accounts (HSA, FSA).
  • Educational expense reimbursement.
  • Paid parental leave.

Other benefits include:

  • Digital mental health services (Talkspace).
  • Flexible work hours (availability varies by office and job function).
  • Training programs.
  • Gallagher Thrive program elevating your health through challenges, workshops, and digital fitness programs for your overall wellbeing.
  • Charitable matching gift program.
  • And more...