For over 20 years PSG has been singularly focused on helping our clients navigate the complex and ever-changing challenges of drug management. Through our leading pharmacy intelligence and technologies, we save our clients billions of dollars every year with an unwavering commitment to serving as your advocate and strategic partner. PSG has market leading technology and administration services for hospitals and health systems.
Our mission is to relentlessly advocate for our clients as we partner together to develop innovative drug management solutions that deliver exceptional strategic insights, financial and clinical value.
As an Audit Analyst, you will be responsible for the production and development of PSG audit deliverables for our clients. This includes review of PBM contracts and related guarantees (financial, performance, network, clinical, etc.) to the plan sponsors (Health Plans, Self-Insured Employers, etc.). It requires the review of prescription claims for pricing and plan design accuracy per the plan documentation provided as well as regulatory requirements. It also includes analysis of administrative fees and applicable drug rebates paid against the contracts.
Scope of work:
- Review and interpret PBM contracts for all relevant pricing terms
- Review plan design documents provided by PBM or client to assess accuracy of benefit administration
- Calculate client contractual financial guarantees, admin fees, rebates and other terms as required by client contract
- Assemble audit reports and summarize findings
- Document all potential issues and track decisions
- Collaborate with account management and pharmacy consultants to discuss results with clients and vendors
- Provide documentation during follow-up negotiations and discussions
- Assist in other financial projects as needed
- Bachelor’s degree in Business, Finance, or other health related field
- At least 3 years of either a) pharmacy benefit audit or b) PBM/Pharmacy claim adjudication research experience, or c) Plan Sponsor financial guarantee or rebate calculation experience
- Working knowledge of the PBM industry and pharmacy benefit claims
- Proficient in Microsoft Office, with extensive experience working with Excel
- Basic SQL query building
- Strong verbal and written communication skills
- Solid, independent worker (work from home)
- Ability to travel (5%)
The national average salary for this role is $60,000 to $90,000 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on your experience, skills, training, certifications and education, while also considering internal equity and market data.
WHY JOIN US?
- 15th Largest Broker in US
- Voted " Best Place to Work" in the Insurance Industry
- Awesome Benefits: 401K matching, Generous Time Off Policy, Flexible Work Options, Medical, Dental, Vision, Pet Insurance, Cancer Insurance, Wellness Programs, Employee Award Programs (Trips!).
EPIC embraces diversity in all its various forms—whether it be diversity of thought, background, race, religion, gender, skills or experience. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard. It is our belief that diversity drives innovation and that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients. An Equal Opportunity/Affirmative Action Employer.