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Prior Authorization Audit Specialist I


PayCompetitive
LocationSan Diego/California
Employment typeFull-Time

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  • Job Description

      Req#: JR101393
      Employer Industry: Pharmacy Benefit Management

      Why consider this job opportunity:
      - Salary up to $75,415
      - Incentive compensation and employee referral bonuses
      - Comprehensive medical, dental, and vision benefits, along with wellness programs
      - Generous paid time off and company-paid holidays
      - 401K plan with company match and tuition reimbursement
      - Opportunity to work with a team that values making a difference in healthcare

      What to Expect (Job Responsibilities):
      - Conduct internal audits of prior authorization staff's work to ensure compliance with established criteria and regulatory requirements
      - Provide feedback and training to staff based on audit results
      - Generate SQL queries to report client-specific data and performance metrics
      - Compile and summarize detailed audit reports for performance tracking and compliance oversight
      - Respond to untimely notifications and manage related documentation through the CMS portal

      What is Required (Qualifications):
      - Associate's degree or equivalent from a two-year college or technical school; or 1-3 years of related experience and/or training
      - Must maintain a current Pharmacy Technician License and/or CPhT Certification without restriction
      - Experience with Windows-based database programs is required
      - Familiarity with Medicare Part D requirements and prior authorization processes
      - Must successfully complete one of the national certification exams or obtain state licensure

      How to Stand Out (Preferred Qualifications):
      - 2 years of direct experience in pharmacy benefit management, healthcare, or managed care
      - Experience writing SQL queries and familiarity with MedOptimize
      - Knowledge of Articulate 360 and MedAccess systems
      - Previous auditing experience in a healthcare setting
      - Strong understanding of interdepartmental processes related to prior authorization and claims

      #PharmacyBenefitManagement #HealthcareCareers #AuditSpecialist #SQLQueries #CareerGrowth

      "We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
      We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."
  • About the company

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