Pbm Operations Analyst Jobs (NOW HIRING)

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

As a member of the Client Audit Management (CAM) team, the Client Audit Specialist is accountable for independently, or in collaboration with senior staff or compliance leader, managing regulatory and/or client-initiated audits. The Specialist is responsible for evaluating and understanding the purpose of various audit types and the related deliverables, developing a holistic understanding of the audit management process, and managing the end-to-end audit activities. This position seeks and obtains additional expertise as indicated from respective Compliance and Operational subject matter experts to meet applicable regulatory, client, and/or functional audit expectations.

Responsibilities

• Review and interpret assigned audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request
• Present sample cases or evidence data for assigned processes and act as a subject matter expert for business requirements, system specification, process flows, process change, Federal and/or State regulations and/or accreditation standards implications
• Develop and maintain key internal and external stakeholder relationships to effectively provide audit consultation, streamline work activity, create/drive efficiencies, and ensure consistent, timely, and accurate audit completion, reporting, or submission of deliverables
• Monitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to Audit Advisors, department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findings
• Perform quality reviews and analysis of audit deliverables to ensure compliance with contractual and regulatory requirements
• Ensure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changes
• Ensure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders
• Integrate project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, throughout the entire audit
• Support department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED is required

• 2 years of relevant work experience in audit, compliance or operations within a regulated environment

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Effective verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefings
• Strong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entities
• Demonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathy
• Organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality
• Agility and adaptability to change and navigate in a demanding, dynamic, fast-paced, intense, and matrix environment
• Ability to use independent judgment and critical decision making in the analysis of audit processes and evidence
• Intermediate to Advanced skills in Microsoft Office Suite (Word, Excel)

Preferred Qualifications

• Health insurance/PBM operations and/or contract audit experience
• Experience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefit
• Project management experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLCis proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.