Remote Biologics Payer Audit & Accreditation Specialist

Mckesson Corporation; United States; Remote; USD 80.000 - 133.000; Vollzeit

Zusammenfassung

McKesson seeks an experienced Biologics Payer Audit & Accreditation Specialist. The role supports PBM/audit management and specialty pharmacy accreditation across Biologics sites, with onboarding to gain proficiency in the second discipline.

Travel about 15% and a strong emphasis on documentation and regulatory compliance are core requirements. Ideal candidates will have 4+ years in specialty pharmacy, PBM, or payer compliance, with experience in audits, accreditation, and related reporting.

Qualifikationen

• 4+ years of combined experience in specialty pharmacy, pharmacy operations, PBM, or pharmacy regulatory and payer compliance.
• 2+ years of PBM audit management and/or PBM auditor experience, including audit response, appeals, and recoupment defense; OR 2+ years of specialty pharmacy accreditation experience (URAC and/or ACHC).
• Working knowledge of pharmacy claims adjudication, claim rejections, and associated resolutions.
• Detail-oriented with strong documentation and follow-through.
• Knowledge of pharmacy systems, pharmacy operations, and pharmacy workflow.
• Proficient in Microsoft Office; Power BI and Excel are a plus.

Aufgaben

• Supports intake, logging, tracking, and timely response of PBM audit requests across all Biologics sites.
• Researches audit findings, gathers supporting documentation, and drafts audit responses and appeals under the direction of the audit function owner.
• Assists in the analysis of audit findings and discrepancy trends to identify recurring root causes.
• Maintains audit trackers, dashboards, and reporting for Operations, Quality, Finance, and Legal stakeholders.
• Supports URAC and ACHC accreditation maintenance, renewal submission, and standards compliance.

Kenntnisse

PBM audit management

Specialty pharmacy accreditation

Pharmacy operations

Pharmacy regulations knowledge

Documentation discipline

Stakeholder management

Power BI

Excel

Ausbildung

4-year undergrad degree

CPhT preferred

Tools

Power BI

Excel

Jobbeschreibung

McKesson seeks an experienced Biologics Payer Audit & Accreditation Specialist. The role supports PBM/audit management and specialty pharmacy accreditation across Biologics sites, with onboarding to gain proficiency in the second discipline.

Travel about 15% and a strong emphasis on documentation and regulatory compliance are core requirements. Ideal candidates will have 4+ years in specialty pharmacy, PBM, or payer compliance, with experience in audits, accreditation, and related reporting.