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Pharmacy Benefit Auditor

3 months ago

Delhi, Delhi, India Response Informatics Full time

The Pharmacy Benefit Setup Auditor has a key role in identifying and evaluating discrepancies and inaccuracies in the pharmacy benefit set up data. Their tasks include ensuring accurate configuration of clients, following audit/setup procedures, and taking part in quality assurance processes.



Duties & Responsibilities:
  • Manage client projects efficiently, ensuring timely completion of setup, case management, and quality assurance tasks.
  • Analyze information to determine if pharmacy benefit changes are necessary.
  • Conduct audits for client and pharmacy benefit setup.
  • Enter pharmacy benefit details into systems according to audit procedures.
  • Evaluate inconsistencies in the data received and escalate for resolution.
  • Review plan documents and input data for new client implementations.
  • Specialize in steps for various project types including benefit implementations, vendor changes, eligibility modifications, and more.
  • Execute key steps for pharmacy benefit changes.
  • Generate configuration documents.
  • Adhere to HIPAA regulations.
  • Perform Quality Assurance testing and report findings.
  • Conduct comprehensive audits and testing of client solutions.
  • Use Microsoft Excel for comparisons and Access for test case details.
  • Document test results accurately.
  • Apply product knowledge to support work requests.
  • Manage daily activities within project management software.
  • Navigate tools efficiently and deliver work accurately.
  • Support projects ensuring client setup accuracy.
  • Achieve Key Performance Indicator goals.

Qualifications and Requirements:
  • Bachelor's degree preferred.
  • 3+ years of related healthcare experience preferred.
  • Understanding of PBM, Payer, and formularies preferred.
  • SalesForce or Other CRM experience required.
  • Proficient in English language skills written and verbal.
  • Proficient in MS Office, advanced Excel skills, and basic Access skills.
  • Experience with reporting tools preferred.
  • Process oriented individual with attention to detail.
  • Passionate about learning and taking on challenges.
  • Adaptable to change and priorities adjustment.
  • Analytical and critical thinking skills required.
  • Must attend 3 weeks of new hire training based on US Central Standard Time (CST).