The PBM Audit Analyst is responsible for auditing, analyzing, and following up on accounts receivable related to Pharmacy Benefit Managers (PBM) in a specialty pharmacy. The role focuses on reviewing and validating payments, identifying discrepancies, and analyzing unpaid payments. The primary function is to audit, document, and refer findings to the teams.
Responsibilities include daily auditing of PBM-related accounts receivable to identify outstanding balances; analyzing claims that are paid, partially paid, or unpaid based on the "View Response" processing; reviewing remittances, reports, and electronic files from PBMs to validate payment accuracy; identifying discrepancies between billed, paid, and contractually expected amounts; clearly and thoroughly documenting audit findings in established systems; referring errors, partial payments, or adjustments to the Operations team; following up on referred cases until resolution without executing reprocessing; preparing lists and reports of audited and referred PBM accounts for discussion with the Supervisor; identifying recurring error patterns, delays, or noncompliance by PBMs; communicating financial risks and trends to the Supervisor or Manager; and supporting internal and external audits related to PBM accounts receivable.
Associate degree in Medical Billing and Coding, Health Services Administration, Medical Administrative Assistant, Medical Records, or related health fields.
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago