Pharmacy Benefit Audit Manager

Myers & Stauffer; Baltimore (MD); On-site; USD 110,000 - 160,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

Vacation and paid holidays

Parental Leave

401K with company matching

Tuition reimbursement

Referral bonuses

Volunteer time and mentor program

Employee development training

Employee Assistance Program

Job summary

Myers and Stauffer LC is seeking a Pharmacy Benefit Audit Manager to lead audit engagements for government PBM programs, ensuring accurate, compliant work products delivered on schedule. You will supervise staff, coordinate schedules, and collaborate with multiple offices while maintaining strict confidentiality of health information.

The role emphasizes project management, data analysis, and effective communication with clients and PBMs.

Qualifications

• Bachelor’s degree required.
• Experience managing project deliverables and staff.
• Proficient with MS Office (Excel, Word, PowerPoint).
• Familiarity with SQL databases.
• Strong analytical and problem-solving skills.
• Well organized with high accuracy and attention to detail.
• Able to manage multiple deadlines and prioritize staff.
• Strong verbal and written communication, report and proposal writing, presentation, and business development skills.
• Minimum of 3 years of PBM/health plan/claims auditor experience.
• Familiarity with PBM contracts and auditing guidelines.
• Client audit experience desirable.
• Occasional travel may be required.

Responsibilities

• Lead staff on engagements and review analysts’ deliverables.
• Coordinate schedules and assignments of engagement staff.
• Meet with clients and their PBMs.
• Develop criteria and programs to analyze pharmacy claims data.
• Review and interpret pharmacy claims data outputs.
• Use spreadsheets to format data for clients.
• Collaborate with multi-disciplinary teams across offices.
• Maintain confidentiality of protected health information and proper documentation.
• Keep documentation in a centralized tracking system.
• Deliver high-quality work within deadlines and support business development.

Skills

Project management

Staff supervision

Data analysis

Communication

Time management

Problem solving

Attention to detail

Business development

Education

Bachelor’s degree

Tools

Microsoft Office

SQL

Job description

Job Description

The Pharmacy Benefit Audit Manager works in a team environment on government client pharmacy benefit manager (PBM) audits and audit related consulting engagements to manage the validation of the integrity and accuracy of the administration of pharmacy benefit programs.This includes all aspects of contracted services including pricing adherence, formulary management, performance guarantees, rebate administration, and operational functions of the PBM.

Essential Functions

• Manage staff responsible for contributing to engagements and assign and review analysts’ deliverables
• Coordinate schedules and work assignments of engagement staff
• Schedule and hold meetings with clients and their PBMs
• Assist in the development of criteria and creation of programs with the program design team used to analyze pharmacy claims data
• Review and analyze pharmacy claims data output provided by staff and interpret and qualify results
• Work with and review spreadsheet applications to manipulate and format data for ease of use by team members and clients
• Interface with multi-disciplinary teams in multiple office locations
• Maintain security and confidentiality of all protected health information when analyzing material and ensure documentation is qualified and retained
• Ensure documentation is qualified and retained in a centralized tracking application
• Deliver high-quality accurate work products to clients within deadlines and contribute to business development and retention initiatives

Preferred Qualifications

• Bachelor’s degree
• Experience managing project oriented deliverables and staff-level employees
• Proficient use of applicable software programs, including Microsoft Office suite (Excel, Word, and PowerPoint)
• Familiarity with database (SQL) applications is beneficial, with a minimum aptitude to learn basic SQL functions
• Strong analytical and problem solving skills
• Well organized with a high degree of accuracy and attention to detail
• Must be able to manage multiple deadlines and prioritize staff assignments
• Very strong verbal and written communication, report and proposal writing, presentation, and business development skills.
• Minimum of 3 years of experience working for a PBM, health plan, pharmacy claims processor, or health claims auditor
• Familiarity with pharmacy benefit design contracts and PBM auditing guidelines
• Client audit experience desirable
• May require occasional overnight travel

Minimum Qualifications

• High school diploma or GED

About Us

Myers and Stauffer LC is a certified public accounting and health and human services consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare & Medicaid Services). We have 45+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 21 offices and have over 900 associates nationwide.

At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government health and human service clients that focus on those in need. We are committed to providing our employees with professional growth and development opportunities, a diverse, dynamic, challenging work environment, and a strong and visionary leadership team. Our firm takes pride in the welcoming and collaborative culture we have throughout our offices. We are always willing to discuss potential flexibility that an employee may need to better suit their work-life wellbeing.

What We Offer

• Health, Dental, and Vision insurance along with other competitive employee benefits for eligible associates
• Vacation time, sick time, and paid holidays
• Paid Parental Leave and available support resources
• 401K with company matching for eligible employees
• Tuition reimbursement, referral bonuses, paid volunteer community service time, mentor program, and a variety of other employee programs and perks
• A combination of technical and leadership development training at each career milestone
• Up to six counseling sessions per year for eligible employees through our Employee Assistance Program

We understand that changing or learning a new industry can discourage strong candidates from applying.