OVERVIEW

Ventegra is a fast paced, innovative virtual company. The Pharmacy Audit Program Manager is responsible leading audit engagements, developing new audit solutions and enhancing existing programs including but not limited to those related to pharmacy fraud, waste and abuse.

REQUIRED SKILLS AND ABILITIES

• Proficiency in software applications including Microsoft Office suite, Microsoft Excel, Microsoft Access, SQL
• Familiarity with state and federal regulations related to pharmacy audit activities
• Thorough knowledge of PBM and pharmacy industry
• Strong interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts.
• Exceptional time management and prioritization skills and proven ability to meet established deadlines.
• Strong strategic focus with ability to deep dive into issues.
• Excellent analytical and problem-solving skills
• Demonstrate resourcefulness and ability to take initiative in the development and completion of projects.
• Expertise in reviewing pharmacy claims data and identifying potential processing issues indicative of potential FWA or system set-up issues
• Able to translate business needs to technical staff (ie. Data analysts/IT) verbally and in writing

EDUCATION AND EXPERIENCE

• Two or more years of experience in a pharmacy setting (e.g., retail, hospital, long-term care, PBM, or PSAO), as a pharmacy technician or pharmacist.
• Nationally Certified Pharmacy Technician (PTCB) preferred
• Two or more years of experience in pharmacy auditing or related pharmacy operations
• Two or more years of Project Management Experience preferred
• Previous experience identifying claims processing issues and/or benefit set-up issues required
• Experience developing audit programs strongly preferred

WORK ENVIRONMENT REQUIREMENTS

A home office setting, free from noise and distraction allowing you to interact professionally both externally and internally.
Job Type: Full-time
Pay: $62,400.00 - $93,600.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Application Question(s):

• How would you describe your management/leadership style?

Experience:

• Pharmacist/Pharmacy technician: 2 years (Required)
• resolving benefit set-up issues: 2 years (Required)
• identifying claims processing issues: 2 years (Required)
• pharmacy auditing: 2 years (Preferred)
• project management: 2 years (Preferred)
• PBM: 2 years (Preferred)

License/Certification:

• PTCB Certification (Preferred)

Work Location: Remot

• Lead and oversee company audit efforts including but not limited to FWA programs and claims adjudication accuracy.
• Overseeing program structure and processes, including the development and monitoring of key performance indicators (KPIs), ensuring all documentation remains current and compliant with federal and state regulations as well as client contracts and industry best practices
• Act as the primary liaison for the external pharmacy audit vendor, overseeing project planning, monitoring progress, resolving action items, and ensuring clear, effective communication with stakeholders throughout the audit lifecycle.
• Lead the roadmap for the Real-Time Pharmacy Audit Program, oversee staff and system operations, establish and enforce policies and procedures, ensure team compliance, and continuously evaluate the program’s return on investment
• Monitor all audit results and lead root cause analysis to remediate and prevent future issues
• Ensure implementation of industry standard claims edits as well as program specific opportunities to address potential fraud, waste or abuse
• Prepare reports and presentations and present audit activities and results to all levels of management
• Proactively research and track state and federal regulations related to pharmacy audit programs and put appropriate measures in place to address potential compliance issues
• Oversee routine and ad hoc state and federal reporting regarding pharmacy audit activities
• Respond to all audit related inquiries including but not limited to those from state regulators, potential and existing clients and providers
• Perform in-depth claims analysis to identify areas of potential FWA and develop ongoing monitoring and algorithms
• Lead internal audit campaigns for financial