Senior Pharmacy Compliance Analyst

SENIOR PHARMACY COMPLIANCE ANALYST
Pharmacy Benefits Management

Jacksonville, FL

Prime Therapeutics LLC (Prime) is an innovative pharmacy care management company. We provide comprehensive pharmacy solutions to manage our clients’ costs and improve the quality of pharmacy care.

We are seeking a professional with a strong retail pharmacy background to perform on-site pharmacy audits of our network pharmacies, monitor pharmacy claims and processes and ensure adherence to Prime’s operating standards and compliance with all applicable State and Federal laws. The Compliance Analyst will review daily claim reports, pharmacy profile reports, and assist with the review of potential fraud and abuse cases involving pharmacies. The individual will also assist with the development and enhancement of audit tools and processes to effectively identify abhorrent claims or pharmacy reimbursements and provide education to Prime’s network pharmacies.

Specific accountabilities:

• Analyze individual pharmacy claims and conduct desk and/or on-site audits of selected pharmacies. Develop longitudinal claims review for single pharmacy locations over time periods.
• Review quarterly pharmacy profiles for contract and standard practice compliance to identify potential non-compliant pharmacies within pharmacy networks.
• Maintain database of all onsite and desk audits performed and track client savings and Prime revenue.
• Compile audit reports for pharmacies and clients for internal use, e.g. collecting funds due, invoicing clients for services, and completing management reports of activities.
• Educate pharmacists on proper submission of on-line transactions and on Prime Therapeutics’ Pharmacy Operating Guidelines.
• Assist with refining and developing updated analytical processes to enhance Prime’s auditing process or determine improper pharmacy activity.
• Establish and maintain client relationships. Educate clients on audit processes and resolve any client issues involving audits. Attend client meetings as needed to discuss audit processes or findings.

At Prime, you will enjoy a supportive environment and plenty of advancement opportunity within a fast-growing business. You will also be rewarded with a competitive salary and benefits package.

For confidential consideration, please apply online at:
www.primetherapeutics.com/aboutrecruitment.htm

Prime Therapeutics LLC

Equal Opportunity Employer


Source - Saint Paul Pioneer Press
REQUIREMENTS
Qualifications:

•Certified Pharmacy Technician with 3 years of retail experience; or equivalent training, education and/or experience. College degree preferred
•Basic skills and understanding of the point of sale, on-line pharmacy claims processing environment. Pharmacy Benefit Management experience is a plus
•Previous experience as an auditor is preferred.
•Ability to travel; some overnight travel is expected.
•Excellent oral, written and interpersonal communication skills.
•Excellent organizational and analytical skills.
•Ability to handle confidential information.
•Ability to work with all levels of the organization.
•Must be self-directed with ability to work with minimal management oversight.
•Working knowledge of MS Word, Excel, and database software