Consultant - Pharmacy Auditor

2 weeks ago

New York County New York, United States Gallagher Full time
About Us:
Buck, a Gallagher company, opens doors to a world of boundless opportunity and innovation. As part of our integrated team, you'll immerse yourself in the exciting journey of serving HR departments and trustees across diverse industries. Together, we'll build pathways to a brighter future for clients worldwide, harnessing the power of collective brilliance and shaping careers that ignite passions.

 

We believe that every candidate brings something special to the table, including you So, even if you feel that you’re close but not an exact match, we encourage you to apply.

Overview:
The Pharmacy Auditor is an integral part of the Pharmacy Audit Team and is responsible for performing and supporting Pharmacy Audits (claims, rebates, operational, Medicare, pre/post-implementation, etc.) to validate that the coverage of a claim and the payment of such claim are in compliance with the contractual, regulatory and custom plan guidelines. Additionally, certain audits validate the proper reimbursement of pharmacy rebates from a Pharmacy Benefits Manager (PBM) to a client per the contractual arrangement. This position is client facing and requires an individual who can effectively manage client expectations as well as the ability to manage multiple projects without compromise of accuracy or timeliness.

Responsibilities:
Project management of Pharmacy Audits from implementation through closure.

Manage and perform audits of pharmacy claim payment data to validate conformance with contractual requirements and plan specifications as assigned.

Review and evaluate Administrative Services Agreement between the employer and PBM.

Work with dedicated data analytics team to define and translate plan provisions for testing purposes ensuring that scope is in line with the statement of work and client commitments. Review client-specific documentation, Summary Plan Description(s) and other documentation, such as copay grids, plan literals, set-up grids, etc., to develop the audit test filters.

Complete contract summary or assist with completion of contract summaries as assigned.

Evaluate the results of the initial claim data tests and determine valid audit samples for review and response by the PBM.

Prepare PBM communications regarding test results, response expectations and clarifications to questions.

Work collaboratively with PBM to resolve exceptions, review supporting documentation and make final claim error determination.

Ensure audit timeline is adhered to and deliver high level of service to clients.

Perform Pharmacy Rebate audits as assigned. (Occasional travel to the PBM is required;10-20% travel possible.)

Prepare and present detailed audit reports which clearly articulate audit findings and recommendations to PBM and client.

Maintain audit project work papers to support audit findings.

Work collaboratively within the audit team as well as with internal and external customers.

Participate in team meetings, conference calls, Zoom meetings, etc. remotely / locally with administrators and audit team 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 supervisor.

Attain billable hours objective (apply acquired skills in client-productive ways).

Qualifications:
Required:

College degree (experience may be considered in waiving the degree requirement)

5+ years’ experience in pharmacy consulting, auditing or other applicable pharmacy industry experience

Must demonstrate a high level of pharmacy benefit, claim or benefit administration knowledge - Medicare experience a strong plus

Proficient in the use of Microsoft Office suite of programs (Word, Excel, PowerPoint).

Excellent organizational and time management skills

Attention to detail and 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

Team player with a strong work ethic

Preferred:

Previous PBM experience a plus

Behaviors:

Excellent oral and written communication skills required

Personable communication style, positive outlook and self-confidence

 

Additional Information:
On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

 Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

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...

We value inclusion and diversity

to review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

 

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