Pharmacy Benefit Auditor

4 weeks ago

Hyderabad, India Response Informatics Full time

The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, and

evaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Their

responsibilities include ensuring the timely and accurate configuration of our clients, adhering to

defined audit / setup procedures, and actively participating in quality assurance processes.

Proficiency in the internal systems of our contracted Pharmacy Benefit Managers (PBMs), as

well as our own internal systems, is essential for this role. While direct interaction with external

customers may not be involved, effective communication skills, the ability to manage tasks

independently, and a knack for analytically resolving complex issues are vital traits. The

individual must diligently follow process documentation to maintain accuracy while also

leveraging critical thinking skills when required.

Duties & Responsibilities:

 Manage concurrent client projects efficiently, ensuring timely completion of critical setup,

case management, and quality assurance tasks within client implementation or benefit

change workflows.

 Test issues and analyze information to determine if client pharmacy benefit changes are

needed.

 Conduct audits for client and pharmacy benefit setup in accordance with client pharmacy

benefit audit procedures.

 Enter pharmacy benefit details into designated systems following the Client audit

process and procedures.

 Recognize, interpret, and evaluate inconsistencies, discrepancies and inaccuracies in

the pharmacy benefit set up data received and alert the proper party for resolution.

 Conduct initial review of incumbent plan documents and data input for new client

implementations, adhering to prescribed systems.

 Specialize in essential steps supporting various project types including new client

pharmacy benefit implementations, medical vendor changes, eligibility modifications,

Third Party Administrators (TPA) transitions, Pharmacy Benefit Managers (PBM) shifts,

and different benefit change requests.

 Responsible for the execution of key steps related to minor/routine pharmacy benefit

changes.

 Generate configuration documents such as Pharmacy Benefit Manager specific

documents.

 Know and adhere to HIPPA regulations

 Perform Quality Assurance (QA) testing according to standard procedures and report

findings for client implementations and existing client pharmacy benefit changes.

 Conduct comprehensive audits and testing of all phases and features of the client

solution to identify and resolve issues.

 Use Microsoft Excel to complete structure comparisons.

 Use Microsoft Access to create test case details to apply for automated testing.

 Acquire proficiency in Pharmacy Benefit Manager (PBM) documentation, software, and

reporting systems for contracted Pharmacy Benefit Managers.

 Document precise test results, including issue locations, screenshots, and member

examples when necessary.


 Apply knowledge of RxBenefits and PBM products/features to support incoming work

requests

 Manage and document day-to-day work activities within a project management software

tool

 Navigate various tools and technologies efficiently.

 Deliver work in a production-based environment, meeting standards for timeliness and

accuracy.

 Support key projects ensuring client setup accuracy, including Client Audit work or

similar assignments beyond the primary Q4 'busy season.'

 Achieve KPI (Key Performance Indicator) goals set by Operations leadership and

department.


Qualifications and Requirements:

 Bachelor’s degree preferred

 3+ years of related pharmacy/healthcare experience, medical auditing or coding

experience is preferred

 Demonstrated understanding of PBM, Payer and formularies and its relevance in

Pharma business is strongly preferred

 SalesForce or Other CRM experience is required

 Confluence experience preferred

 Proficient in English language skills both written and verbal

 Proficient in MS Office (Including Word, Excel, Outlook, SharePoint), advanced Excel

skills (Macros, VLOOKUP, etc.) and basic Microsoft Access skills required

 Experience with reporting tools (QLIK, PowerBI, DataNet, Tableau) is preferred

 Process minded individual with a strong attention to detail who understands the

importance of following a consistent process to maximize efficiency; quality

 A passion for learning and a willingness for taking on new challenges

 Must adapt well to change and successfully set and adjust priorities as needed

 Possess analytical and critical thinking skill

 Must be able to attend 3 weeks of new hire training that follows the US Central Standard

Time (CST) time zone

  • Pharmacy Benefit Auditor

    3 weeks ago

    hyderabad, India Response Informatics Full time

    The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, andevaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Theirresponsibilities include ensuring the timely and accurate configuration of our clients, adhering todefined audit / setup procedures, and actively participating in quality...

  • Pharmacy Benefit Auditor

    4 weeks ago

    Hyderabad, India Response Informatics Full time

    The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, andevaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Theirresponsibilities include ensuring the timely and accurate configuration of our clients, adhering todefined audit / setup procedures, and actively participating in quality...

  • Pharmacy Benefit Auditor

    3 weeks ago

    Hyderabad, India Response Informatics Full time

    The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, andevaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Theirresponsibilities include ensuring the timely and accurate configuration of our clients, adhering todefined audit / setup procedures, and actively participating in quality...

  • Pharmacy Benefit Auditor

    3 weeks ago

    Hyderabad, India Response Informatics Full time

    The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, and evaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Their responsibilities include ensuring the timely and accurate configuration of our clients, adhering to defined audit / setup procedures, and actively participating in quality...

  • Pharmacy Benefit Auditor

    3 weeks ago

    hyderabad, India Response Informatics Full time

    The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, and evaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Their responsibilities include ensuring the timely and accurate configuration of our clients, adhering to defined audit / setup procedures, and actively participating in quality...

  • Pharmacy Incharge

    2 months ago

    Hyderabad, India Zoi Health Pvt Ltd - Attapur Full time

    * We are looking for an efficient pharmacy incharge to ensure smooth daily operations at our pharmacy. In this role, your duties will include managing prescriptions, controlling the pharmacy's inventory, and executing supply and shipment orders. You will also be required to oversee pharmacy personnel. To ensure success as a pharmacy incharge, you should...

  • Pharmacy Assistant

    3 weeks ago

    Hyderabad, India Bharat Vikas Parishad Generic Medical Stores Full time

    **Job Title: Pharmacy Aide/Assistant** **Desired Profile**:Persons who possess Practical retail medicines dispensing knowledge. Preferable 1-4 years of experience persons in retail outlets/Pharmacies. **Experience**:Minimum 1-4 years asPharmacy Aide/Assistant are considerable **Industry Type**:Pharma, FMCG, any industry. **Role**:Pharmacy...

  • Pharmacy Incharge

    3 weeks ago

    Hyderabad, India Olive Hospitals Full time

    Overseeing sales assistants, cashiers, shelf stockers, and other pharmacy employees. - Preparing drugs and executing prescription orders for collection or delivery. - Ordering pharmacy supplies and controlling the inventory on a daily basis. - Enforcing best practice protocols when storing prescription drugs and controlled substances. - Verifying...

  • Pharmacy Aide/assistant

    2 months ago

    Hyderabad, India Bharat Vikas Parishad Generic Medicals Full time

    **Job Title: Pharmacy Aide/Assistant** **Desired Profile**:Persons who possess Practical retail medicines dispensing knowledge. **Experience**:Minimum 1- 4 years as Pharmacy Aide/Assistant are considerable **Industry Type**:Pharma, FMCG, any industry. **Role**:Pharmacy Aide/Assistant **Functional Area**:Retail Pharmacy, Hospital Pharmacy **Education:...

  • Pharmacy Aide/assistant

    3 weeks ago

    Hyderabad, India Bharat Vikas Parishad Generic Medicals Full time

    **Job Title: Pharmacy Aide/Assistant** **Desired Profile**:Persons who possess Practical retail medicines dispensing knowledge. Preferable 1-4 years of experience persons in retail outlets/Pharmacies. **Experience**:Minimum 1-4 years asPharmacy Aide/Assistant are considerable **Industry Type**:Pharma, FMCG, any industry. **Role**:Pharmacy...

  • Quality Auditor

    1 week ago

    Hyderabad, Telangana, India UnitedHealth Group Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

  • Auditor, QA Compliance

    1 week ago

    Hyderabad, Telangana, India AbbVie Full time

    **Company Description** The function of Audit and Compliance Co-Auditor is to assist and support the Internal Audit and Compliance Team in performing evaluations for compliance with US and foreign regulation requirements (mínimally may include the Americas, Asia, Africa, Australia, European Middle East regions). The Co-Auditor will also work with the...

  • Auditor, QA Compliance

    1 week ago

    Hyderabad, Telangana, India AbbVie Full time

    Company DescriptionThe function of Audit and Compliance Co-Auditor is to assist and support the Internal Audit and Compliance Team in performing evaluations for compliance with US and foreign regulation requirements (mínimally may include the Americas, Asia, Africa, Australia, European Middle East regions). The Co-Auditor will also work with the Internal...

  • Pharmacy Aide/assistant

    2 months ago

    Moosapet, Hyderabad, Telangana, India Aswini Homeo & Ayurvedic Products Pvt Ltd Full time

    **Job Title: Pharmacy Aide/Assistant** **Responsibilities**: - a. Assisting to Pharmacist_ - b. Dispense medicines as per prescription_ - c. Ensure availability of medicine in the pharmacy_ - d. Taking care of counter sales_ - e. Verification of new products, MRP, Date of Manufactured & Date of Expiry_ **Desired Profile**:_Persons who possess Practical...

  • Pharmacy Purchase Executive

    5 days ago

    Hyderabad, Telangana, India Ankura hospital for women & Children Full time

    **JOB ROLES & RESPONSIBILITIES**: - Procurement of pharma items from central pharmacy. - Raising pharmacy indents. - Gathering vendor / company information. - Meeting vendor / Company representative for gathering data. - Follow up with pharmacy for identifying non moving and expiry drugs. - Prepare comparative quotes statements. - Monthly review with stock...

  • Pharmacist

    2 weeks ago

    Madinaguda, Hyderabad, Telangana, India MedQ Pharmacy Full time

    Looking for Pharmacist for our Medical Shop MedQ Pharmacy located at Mythrinaga, Srikara Hospital Lane, Madinaguda, Hyderabad. Must have - Basic Knowledge on Medicines Polite and easy going Good to have - Pharmacist experience B Pharmacy Degree or any other equivalent degree **Job Types**: Full-time, Regular / Permanent **Salary**: ₹10,000.00 -...

  • Auditor

    4 weeks ago

    Hyderabad, India S3 Connections Pvt Ltd Full time

    A Leading Client in USA is looking for **AUDITOR** **Job Location: India** **Job type: Remote** **To Work on US Shifts (6.30pm - 3.30am)** **Responsibilities for Auditor** Develop audit objectives, plans, and scope by reviewing available information and conducting research Help design, implement, and maintain internal audit procedures and risk assessment...

  • Auditor, QA Compliance

    1 month ago

    Hyderabad, India AbbVie Full time

    Job DescriptionThe function of Audit and Compliance Co-Auditor is to assist and support the Internal Audit and Compliance Team in performing evaluations for compliance with US and foreign regulation requirements (minimally may include the Americas, Asia, Africa, Australia, European Middle East regions). The Co-Auditor will also work with the Internal audit...

  • Auditor, QA Compliance

    3 weeks ago

    Hyderabad, India AbbVie Full time

    Job DescriptionThe function of Audit and Compliance Co-Auditor is to assist and support the Internal Audit and Compliance Team in performing evaluations for compliance with US and foreign regulation requirements (minimally may include the Americas, Asia, Africa, Australia, European Middle East regions). The Co-Auditor will also work with the Internal audit...

  • Auditor, QA Compliance

    1 week ago

    Hyderabad, Telangana, India AbbVie Full time

    Job DescriptionThe function of Audit and Compliance Co-Auditor is to assist and support the Internal Audit and Compliance Team in performing evaluations for compliance with US and foreign regulation requirements (minimally may include the Americas, Asia, Africa, Australia, European Middle East regions). The Co-Auditor will also work with the Internal audit...