Senior Pharmacy Audit Analyst at Vital Care Infusion Services

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Aug, 26

Salary

75255.0

Posted On

14 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Pharmacy Auditing, Analytical Skills, Quantitative Analysis, MS Office, CareTend, Pharmacy Law, Project Management, Problem Solving, Customer Service, Business Acumen, Communication Skills, Infusion Medication Knowledge, Compliance Management, Data Verification, Training Development, Reporting

Industry

Hospitals and Health Care

Description

Recognized as a “Best Place to Work Modern Healthcare” – Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters. Vital Care (www.vitalcare.com [http://www.vitalcareinc.com]) is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations. What we offer: * Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts. * Paid time off, personal days, and company-paid holidays. * Paid Paternal Leave. * Volunteerism Days off. * Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance. * 401(k) matching and tuition reimbursement. * Employee assistance programs include mental health, financial and legal. * Rewards programs offered by our medical carrier. * Professional development and growth opportunities. * Employee Referral Program Job Summary: The Senior Pharmacy Audit Analyst is an integral member of the Vital Care Infusion Services team and is responsible for supporting the Vital Care pharmacy network and successfully responding to pharmacy payer audits. This position works closely with the franchise network of pharmacies to support timely and accurate responses to payer claims and desk audits. This position will also be the audit team's lead role and help develop and execute project plans to fulfill these needs accordingly. Duties/Responsibilities: * Manages and coordinates all phases of pharmacy audits, including the preparation and support of completing pharmacy payer audits, obtaining claim data, reviewing dispensing activities for billing errors, obtaining and reviewing requested documentation, reviewing federal/state/local pharmacy laws, documenting audit results, and coordinating the submission of audit responses with Vital Care pharmacies. * Serve as a team lead to identify and analyze pharmacy audit project needs in supporting franchises. Oversee the management and implementation of projects as identified. * Manages company initiatives to improve compliance, decrease costs, and grow business related to pharmacy audit services. * Utilizes CareTend as well as Vital Care’s internally developed systems and reports to accomplish work deliverables. * Communicates with pharmacies to ensure claims data verification and request claim adjustments from Vital Care’s Revenue Cycle Department as needed, which includes, but is not limited to: (1) Making outbound calls to pharmacies and (2) following up with pharmacies by faxing and emailing related documents. * Communicates with pharmacy payers, auditors, consultants, etc., to discuss audit requests, responses, and results as needed using various media platforms (i.e., email, phone calls.). * Prepares appropriate documentation for pharmacy payer audits as appropriate. * Performs follow-up inspection of claims data based on extrapolations from initial audit results. * Prepares correspondence to pharmacy providers, requesting documentation to validate detected claim discrepancies. * Prepares audit outcome documentation for pharmacies. * Documents audit results within internal systems. * Follows company protocol for notifying management of potential fraud, waste, and abuse. * Performs report preparation, participation in special projects, problem resolution, and other activities that support the auditing process. * Engage in consistent and timely follow-up communications with franchise partners using various media platforms (e.g., email, and Microsoft Teams). * Develop creative training programs in Vital Care’s Learning Management System (LMS) that will assist with franchise education. * Represents the organization at national, regional, and local conferences if needed, in focus on pharmacy audits. * Assess, on an ongoing basis, the effectiveness of training programs and resources. * Perform other related duties as assigned. Required Skills/Abilities: * Demonstrated analytical, quantitative, and organizational skills, providing the ability to analyze progress, identify trends and anomalies, and recommend needed improvements. * Solution-oriented and resourceful, demonstrates excellent problem-solving and customer service skills. * Intermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, and Outlook) required. Familiarity with pharmacy dispensing software (e.g., CareTend, CPR+, etc.) is highly desirable. Strong aptitude to learn and adapt to new programs. * Knowledge of specialty and/or infusion medications and standard dosages. * Strong knowledge of the practice of pharmacy, including statutory laws, regulations, and methods of filling and filing prescriptions. * Strong business acumen with the ability to quickly grasp issues and understand strategy and demonstrated the ability to make sound business decisions. * Demonstrated process and project ownership orientation with the ability to manage priorities and meet time commitments. * Ability to effectively collaborate and communicate project status with department team and Company leadership. * Ability to work independently with minimal direction and good decision-making ability. * Highly skilled communicator in verbal, written, and oral presentation of information. Education and Experience: * Minimum of 3 years of experience in the areas of pharmacy audits. * For consideration, candidates will need 3+ years of pharmacy experience (or equivalent combination of education and experience). Experience in infusion, long-term care, specialty, or mail-order pharmacy is highly desired. Physical Requirements: * Sitting: Prolonged periods of sitting are typical, often for the majority of the workday. * Keyboarding: Frequent use of a keyboard for typing and data entry. * Reaching: Occasionally reaching for items such as files, documents, or office supplies. * Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork. * Visual Acuity: Good vision for reading documents, computer screens, and other detailed work. Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews. Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status, or any other basis protected by applicable federal, state, or local law. Vital Care Infusion Services participates in E-Verify. This position is full-time. The salary range for this position is $59,838 - $75,255

Responsibilities

The Senior Pharmacy Audit Analyst manages all phases of pharmacy payer audits and serves as a team lead to support the franchise network. They are responsible for reviewing dispensing activities for billing errors, ensuring compliance, and developing training programs for franchise education.