This position is responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. Utilize current programs and analytical procedures and existing tools (including Access, Excel) while utilizing personal knowledge of medications to identify clients, members and claims representing financial risks. Perform efficient and effective investigational audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals. Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective opinion on the accuracy and legitimacy of claims audited. Analyzes audit findings to determine validity of any identified discrepancies. Has full responsibility for handling/researching complex issues identified during an audit. Prepare formal and thorough written reports. Submit findings to management for review. Responsibility for providing ad hoc reports to key business owners. Special projects as assigned and as needed.
- 0-2 years of experience with a Bachelor's degree or 6-8 years of experience without
- PBM, healthcare, financial analysis, accounting or auditing experience preferred
- Certified Pharmacy Technician preferred
- Highly proficient in data warehousing, database and spreadsheet applications
- Proficiency in Curascript proprietary systems preferred
- Excellent organizational and interpersonal skills
- Excellent verbal and written communication skills
- Excellent interpersonal skills and the ability to effectively communicate with all levels of management
- Ability to work cross functional departments to research and resolve issues using innovative solutions
- Demonstrated ability to meet multiple deadlines and manage a dynamic workload
- Ability to work a flexible schedule to accommodate project deadlines
- Ability to present audit findings and recommendations to business owners
- Demonstrated analytical and problem solving skills
- Ability to use judgment in analysis of findings and ability to outline recommendations for specific outcomes
- Ability to handle sensitive or confidential information is critical to success of the role
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.
None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.
Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.
- 2 years ago - save job