Manager, Pharmacy Audit

About this role

Exemption Status: United States of America (Exempt)

$81,581 - $110,136 - $138,690 “Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description Summary

Manages Pharmacy Audit and FWA operations while serving as a cross-functional leadership resource across Pharmacy Compliance and FWA functions. Supports audit, investigations, credentialing, analytics, reporting, program initiatives, and operational continuity as business priorities require.

Essential Duties and Responsibilities include the following. Other duties may be assigned. • Develops and implements premium strategy and services to meet organizational and client audit, FWA needs. • Manages Pharmacy Audit and FWA operations to ensure effective service delivery to all stakeholders including clients, Account Service, other departments, etc. • Designs audit and FWA programs to reduce unnecessary drug costs, recoup monies and provide cost savings for MedImpact clients. • Establishes standards and procedures for the quality and timeliness of work to ensure accuracy in identifying exposures and documenting potential risk areas for MedImpact and/or clients • Establishes procedures to ensure compliance with federal regulations and Company network agreements. Ensure auditors understand NABP and state specific pharmacy laws impacting claims review prior to audits. • Develops and conducts training for audit staff. Ensures continuing education involving department process changes or laws affecting pharmacy audits. • Ensured all audit contractual obligations are completed in a timely manner and meet MedImpact’s highest expectations. • Recruits, manages and retains the necessary resources to successfully perform the duties for the Provider Auditing group. • Provides day-to-day management of department, including developing and administering policies, business processes and quality standards, and developing and managing a department budget. • Ensures that deliverables are on time, within budget, and meet the quality levels expected by internal and external customers. • Manages the overall planning, coordination of schedules and completion of desk audits and on-site audits. • Ensures summary and follow-up reports outlining audit findings and detail listing of discrepancies identified during the audit process are reported to the Director, Pharmacy Compliance, FWA via the Report of Findings approved template. • Documents, monitors, and follow-ups on all client speciifc audit, FWA requests, research and analysis. • Assists in the implementation of a tracking system for audit claims, FWA as a measure of department performance. • Develops and maintains reporting tools for the department, Pharmacy Adjudication Committee (CAC), law enforcement and clients. • Responsible for intervening and resolving issues, problems, and/or concerns from clients, and informing senior management regarding client issues that may have an adverse impact. • Provides leadership coverage, operational oversight, and management support for Pharmacy Compliance and FWA functions during periods of organizational change, staffing transitions, leave coverage, special projects, or increased business demand. • Serves as a cross-functional leader within the Pharmacy Compliance and FWA organization, providing operational support, project leadership, subject matter expertise, and management coverage across multiple functional areas as business priorities require. • Participates in initiatives involving audit, investigations, credentialing, analytics, compliance operations, reporting, and other departmental functions to ensure effective service delivery, operational continuity, and organizational flexibility. • Provides leadership support and subject matter expertise for pharmacy credentialing and recredentialing activities, assisting with regulatory compliance, accreditation requirements, audits, and special projects as business needs require. • Supports fraud, waste, abuse, and compliance investigations through data analysis, audit activities, case reviews, and collaboration with internal stakeholders and regulatory agencies, as appropriate. • Leverages reporting, analytics, and operational data to identify trends, risks, anomalies, and opportunities for process improvement across Pharmacy Compliance and FWA programs. Develops and maintains management reporting and performance metrics to support business decisions. • Partners with business, operational, and technology teams to support the development, implementation, testing, and enhancement of Pharmacy Compliance and FWA-related programs, workflows, controls, and system capabilities. • Supports client implementations, regulatory examinations, accreditation reviews, client audits, and requests for in

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