Pharmacy Audit Engineer

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Conduct audits of pharmacy claims to verify adherence to PBM contracts.

• Coordinate calls with PBMs to gather claims audit information.

• Execute data loading, perform quality checks on data, and carry out data reconciliation.

• Generate and assess reports from Oracle outputs.

• Carry out ad-hoc analyses as needed.

• Review and assess PBM contracts.

• Prepare documentation to support audits.

• Collaborate with the client support team to create deliverables for PBMs and clients.

• Employ ad hoc SQL automation and establish a tailored framework for project completion.

• Plan, prioritize, and execute financial and operational audits evaluating the accuracy of PBM contracts, controls, and financial data.

• Design and implement audit strategies for assigned projects in accordance with Remedy's internal Audit Standards.

• Manage multiple audits simultaneously, each with distinct deadlines.

• Analyze and verify the integrity of master files, profiles, and changes to tables.

• Enhance audit automation processes based on insights, industry developments, and technological advancements.

• Monitor open audit observations and coordinate follow-up on remediation efforts with PBM and Remedy account teams.

• Draft audit reports that communicate analysis results to the Remedy account team.

• Fulfill daily and weekly ad hoc data analytics requests as prioritized by Department Management.

• Assess system functionality to identify opportunities for improving operational efficiency.

• Adhere to regulatory compliance standards, policies, procedures, HIPAA requirements, and best practices.

⛳️ Requirements

• Bachelor's degree in computer science, engineering, or a related analytical field.

• Strong proficiency in creating and managing database tables, ETL processes, complex Oracle/SQL queries, and maintaining code.

• Understanding of Dimensional Models, with experience in manipulating models and developing business logic.

• Relevant experience showcasing problem-solving skills, financial insight, and analytical output.

• Proficient in MS Office applications including Excel, Word, PowerPoint, and PowerBI.

• Exceptional verbal and written communication abilities to organize and present data effectively.

• Experience in building and maintaining effective collaborative relationships with clients and internal stakeholders.

• Strong sense of ownership over projects, with the ability to manage a high volume of projects efficiently.

• Excellent problem-solving, critical thinking, and analytical skills, capable of working within cross-functional teams.

• Ability to adapt to changing priorities and directions in a project and deadline-driven environment.

• Preferred but not mandatory: Experience in Project Management.

• Preferred but not mandatory: Familiarity with version control systems (git, bitbucket).

• Preferred but not mandatory: Knowledge of visualization tools (PowerBI/SSRS preferred).

• Preferred but not mandatory: Proficiency in Python (pandas, NumPy, and general data manipulation techniques).

• Preferred but not mandatory: Familiarity with low-code to no-code solutions.

• Preferred but not mandatory: Experience with Pharmacy and/or Medical claims data.

• Preferred but not mandatory: Experience in pharmacy claims auditing and/or knowledge of pharmacy claims data.

🏝️ Benefits

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance.

• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement.

• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services.

• Paid Time Off.

• Holidays.

• Preferred Partner Discounts.