Job: Pharmacist Auditor REMOTE

Jobing Description

Job Description - Pharmacist Auditor - REMOTE (58101)

Job Description

Pharmacist Auditor - REMOTE(

Job Number:
58101)

Description

Xerox Corporation is a $22 billion leading global enterprise for business process and document management. Through its broad portfolio of technology and services, Xerox provides the essential back-office support that clears the way for clients to focus on what they do best: their real business. Headquartered in Norwalk, Conn., Xerox provides leading-edge document technology, services, software and genuine Xerox supplies for graphic communication and office printing environments of any size. Through ACS, A Xerox Company, which Xerox acquired in February 2010, Xerox also offers extensive business process outsourcing and IT outsourcing services, including data processing, HR benefits management, finance support, and customer relationship management services for commercial and government organizations worldwide. The 130,000 people of Xerox serve clients in more than 160 countries.

If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.

May perform one or more of the following:

Preferred Incumbent can be located anywhere in the Mid-West or East Coast regions and will travel to locations provide audit services to one or more states including, but not limited to: Ohio, Kentucky, Indiana, Missouri.

Functional Description:

I. Pharmacy Auditor Summary:
Conduct Home Infusion Therapy audits, investigations, and other pharmacy-related audits.

II. Primary Job Responsibilities:

Field audits
Perform field audits at provider sites by traveling to provider-sites and examining source documents such as prescriptions and patient medical records.
Validate and document all audit findings.
Conduct audits in accordance with audit guidelines.
Be able to identify fraud and abuse, and document it.
Interview providers and witnesses regarding potential fraud schemes, and document such interviews.
Back up all findings with applicable citations in federal, state and plan rules & regulations.

Audit support activities
Prepare for audits, making sure that the appropriate data samples are drawn, work papers are ready and pharmacies are notified.
Conduct In-house audit tasks.
Conduct Desk-Audits of provider data to target inappropriate therapy, questionable billing practices and aberrant behavior.
Perform post-audit activities such as discrepancy validation and other follow up.
Generate final reports for the client.

Audit Follow-Up
Edit, validate and report audit findings.
Provide back-up documentation during negotiation proceedings.
Participate in administrative hearings and court proceedings when necessary.

Other analyses
Conduct other audit and data analyses as required. Review data and claim information to support account management.

Education and Typical Years Experience

III. Education and Experience:

Education / Licensure:
Current licensure as a registered Pharmacist.

Experience / Background:
A minimum of three to five years experience in retail or specialty pharmacy. Home Infusion experience preferred.
No record of felony convictions or any record of Medicaid or Board of Pharmacy sanctions for fraud, abuse or inappropriate billing.
Intimate knowledge of pharmacy operations, third party billing & claim adjudication.
Investigative or auditing experience a plus.
Experience with word processors, spreadsheets & databases

Special Requirements

IV. Job Skills / Requirements:
1. Thoroughness: Complete tasks 100% and pay attention to detail. Be willing to go the extra mile to follow through on audits, run down leads, dig for fraud and abuse. Properly and consistently adhere to standard auditing and investigative guidelines, document all findings and communications, and create a complete audit trail. Respond to all client requests. Let nothing slip through the cracks.
2. Communication: With good grammar and form, cohesively & concisely communicate written audit reports and work product documentation. Be able to verbally communicate in a professional & pleasant manner in potentially combative audit situations.
3. Confidence / Self Assuredness: Must be able to handle irritated or irate audit subjects and diffuse tense situations. Must be able to operate in a sometimes-tense environment and still reach objective of completing the audit.
4. Results Orientation: Take the initiative to tweak & redirect efforts in order to make the account successful. Chase down the leads that will yield the greatest degree of fraud and recoveries.
5. Flexibility: Must adapt and be able to handle a changing schedule and ranging responsibilities.
6. Problem-Solver: Must be able to think through complex situations and fraud schemes, and identify the pattern of abuse. Must be able to work independently and get the job done with minimal supervision.

***Full-time position requiring up to 50% travel. Audit travel may require up to 4 days per week of travel depending upon location. For example - departure for audit locations on Sunday evening and return to home location on Thursday

ACS is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender/sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, or any other group protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodation(s) by calling 866-419-2226 or by sending an e-mail to accommodations@acs-inc.com.

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