Are you an Internal Audit Manager based in Arkansas?
Are you looking for an exciting new opportunity in 2022?
If this sounds like a good fit for you please apply below!
* Set up a plan summary based on customer plan requirements/ regulatory requirements
* Analyse the conditions attached to the plans
* Perform process and data discovery discussions to identify the systems and data points of interest
* Ability to query and extract necessary information from claims and Rx softwares
* Conduct analysis and identify exceptions, issues, trends and patterns of interest
* Audit claims (basis understanding of different types such as co-pay, patient pay, DAW and also different kinds of plans, compounds, formularies, wild card drugs
Overall,range of experiences could include:
* Performing complex customer audits in the Pharmacy Benefits Management industry with deep domain expertise across internal workings of the PBM industry, and Med D/EGWP operations/claims adjudication
* Audits and monitoring activities to ensure compliance with company policies, client contracts, and regulatory guidelines
* Support Audit activities where there are customer or medicare requirements for compliance and assess compliance gaps
* Review business policies, procedures, perform data analysis across multiple source systems to assess compliance to contract and/ health plan requirements
* Ensure timely completion of audits, recommend measures to continuously build and improve the Audit process
* Reporting audit results to management and assist with the development of remediation plans as necessary
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