Position Overview: Support all aspects of the pharmacy services compliance program for Medicare, Medicaid and Commercial lines of business. Assume the primary role of interfacing with the Compliance department, auditors, vendors and pharmacy staff for purposes of monitoring and ensuring compliant pharmacy operations. Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting the Pharmacy Department. Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance.
Serve as an inter-departmental liaison for pharmacy compliance and FWA activities.
Work Experience: Minimum of four years of healthcare or health insurance industry required. Strong preference for experience in auditing or compliance related role.
Education, Certificates, Licenses: Bachelor’s degree strongly preferred. An equivalent combination of education and healthcare (or health insurance industry) experience will be considered. Pharmacy Technician certification preferred.
Knowledge: Understanding of Medicare and Medicaid rules and regulations preferred. Strong computer skills. Highly proficient verbal and business writing skills. Understanding of Medical Terminology preferred. Ability to work under strict timelines and pressure situations. Requires ability to define and prioritize problems and manage workload without direct supervision.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.