PA Audit Technician I If youre interested in a career within a customer-focused, team-oriented environment that rewards innovation, quality, integrity and collaboration, MedImpact Healthcare Systems, Inc. welcomes your application. MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets. Position Summary The PA Audit Technician I assists the PA Audit Team in the successful preparation, planning, execution, and follow up of audits. This position leads client PA audits, coordinates follow up to PA audit findings, monitors corrective action plans, and solves client issues related to PA audits. Additionally, this position works with the PA Audit and PA/UM teams to identify potential and actual client PA issues that may impact client members, and assists with communication of any findings to clients. Essential Duties and Responsibilities include the following. Other duties may be assigned. Serves as a technical subject matter expert (SME) for all Part D audits by CMS Leads assigned PA/UM and Appeals audits as the primary participant in collaboration with the PA Audit Pharmacist Effectively presents individual client coverage determinations and redeterminations and responds appropriately to questions from CMS auditor(s) and clients during an audit Supports Formulary Administration (FA) audits and responds to questions related to PA and Appeals processes from CMS auditor(s) and clients during an FA audit Project manages to ensure departmental goals and initiatives are achieved; When not in audits, learns all aspects of the current PAUM and Appeals program for assigned clients, MedImpact internal processes, and applicable regulations Understands, and can provide Quality Check (QC) to, PA audit related reports and all supporting deliverables through a CRM tool (Salesforce) Audits established guidelines for CMS required measurements and protocols Works with the PA Audit team with the initiation, performance in, progression, completion, and follow up of CMS client PA audits and other PA audits as needed Supports PA Audit Team with the generation and review of PA impact analysis reports, and other client requests related to PA Communicates any errors/issues discovered and provides suggestions for impact analysis as appropriate Works with the PA Audit Team in collaboration with PA/UM process owners, External Compliance Support, and Government Programs and Services regarding communication of PA related compliance issues and potential compliance issues (PA Communication Memos) to clients Works with PA/UM, PA QI team, and External Compliance Support for corrective action plans and improvement in processes related to audit findings and potential audit or compliance findings Develops capability to use all MedImpact systems relevant to the position Supports Appeals & Grievances Team, PA/UM Team, and Clinical PA Guidelines Team, as needed Trains staff in PA audit requirements as needed Education and/or Experience For consideration, candidates will need an Associates degree along with one (1) to three (3) years job related experience and/or training; or equivalent combination of education and experience. Prior PBM, healthcare, or managed care experience is required. Computer Skills To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases. Certificates, Licenses, Registrations Maintains a current Pharmacy Technician License and/or CPhT certification without restriction Other Skills and Abilities Prior authorization, data analysis, and claims research experience preferred; Analytical skills with Health Informatics experience preferred; Experience in promoting disease management or drug cost management programs preferred. Travel This position may require travel for those located outside of the geographic location of the audit. Attendance may be required at various local training sessions and/or meetings or travel to a client site. This position is eligible for Employee Referral Bonus at Level I EOE, M/F/D/V OSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.