Pharmacy Audit & Credential Coordinator

Summary

JOB DESCRIPTION

The OSPS (Omnicell Specialty Pharmacy Services) Pharmacy Audit and Credentialing Coordinator supports the OSPS PSAO through various functions, including but not limited to coordinating and responding to PBM and other third-party audits, maintaining pharmacy credentialing, and investigating third-party rejections. This role also supports managed care contracting efforts and special projects. The position is responsible for creating PSAO analyses and building reports around rejections and contracting.

Essential Functions

• Assist with responding to PBM and third-party audits, ensuring all requests are handled in a timely manner.
• Coordinate the preparation of third-party audit responses and appeals when necessary.
• Facilitate the completion of audit documentation from pharmacies, reviewing for accuracy and completeness, and assist with submitting the documentation to the requesting third party by the deadline.
• Travel to on-site audits as needed in a support role.
• Provide education and guidance to pharmacy staff on audits, rejections, and MAC Appeals when appropriate.
• Complete required information for various PBMs, Government, and State Agencies for new pharmacy participation and updates for existing pharmacies.
• Maintain active credentialing with all entities as required.
• Perform outreach to PBMs to verify current contracted rate reimbursement and perform appeals when appropriate.
• Maintain contracts/carrier codes in the third-party reconciliation system, and audit the financial aspect of claims.
• Keep up-to-date with the PBM contract listings, including reimbursement rates and terms.
• Manage the Daily Rejection Report and investigate third-party rejections from pharmacies. Identify opportunities for pharmacies and pursue networks based on reporting and rejections.
• Analyze rejected claims and billing issues, collaborating with Accounting/Finance and Operations departments to ensure accurate audit/pricing reports.
• Assist in managing formal communications with Pharmacy Benefit Managers and Managed Care Organizations.
• Perform other duties as assigned.
  
  
  

Education And Experience

Required:

• High School Diploma / GED
• Active Nationally Certified Pharmacy Technician (CPhT); PTCB or ExCPT tests accepted.
• Minimum of 1 year of related work experience in a specialty pharmacy environment.
  
  
  

Preferred:

• Minimum of 2 years of experience working with pharmacy dispensing systems.
• Experience with PBM/Payor audits.
• Knowledge of pharmacy licensing and Payor enrollment.
  
  
  

Competencies

• Initiative and professionalism in conduct and appearance; punctual and efficient.
• Strong communication, interpersonal, and organizational skills.
• Ability to interact with individuals over the phone, sometimes in stressful situations.
• Extremely detail-oriented and able to manage multiple tasks simultaneously.
• Proficient in Microsoft Office.
• Strong work ethic with excellent time management and problem-solving skills.
• Ability to work both independently and as part of a team.
• Proactive, resourceful, with excellent follow-up and organizational skills.
• Able to coordinate multiple activities and tasks in a fast-paced environment.
• Strong interpersonal skills and ability to interact well with all levels of clients, customers, and internal personnel.
• Able to work in the office or remotely.
• Willingness to travel up to 25%.
  
  
  

About Us

Since 1992, Omnicell has been committed to transforming pharmacy care through outcomes-centric innovation designed to optimize clinical and business outcomes across all settings of care. We strive to be the healthcare provider’s most trusted partner by our guiding promise of “Outcomes. Defined and Delivered.”  

Our comprehensive portfolio of robotics, smart devices, intelligent software, and expert services is helping healthcare facilities worldwide to improve business and clinical outcomes as they move closer to the industry vision of the Autonomous Pharmacy. 

Our guiding principles inform everything we do: 

• As Passionate Transformers, we find a better way to innovate relentlessly. 
• Being Mission Driven, we consistently deliver on our promises. 
• Our Entrepreneurial spirit makes the most of EVERY opportunity for innovation. 
• Understanding that Relationships Matter creates synergies that yield the greatest benefits for all.
• In Doing the Right Thing, we lead by example in ALL we do. 
  
  
  

We value creating an inclusive culture and a healthier world through ESG initiatives, Employee Impact Groups, learning, well-being programs, and more. Join us in transforming the pharmacy care delivery model, making patient care safer and smarter for all.

About The Team

Omnicell is dedicated to fostering a diverse and inclusive workplace. We welcome applications from all individuals, valuing a wide range of perspectives and backgrounds. As an equal opportunity employer, we do not discriminate based on race, gender, religion, sexual orientation, gender identity, national origin, veteran status, or disability. We are committed to making our recruitment process accessible to everyone. We offer support and reasonable adjustments for individuals with disabilities during our hiring process. If you need assistance, please contact us at Recruiting@omnicell.com .

At Omnicell, respect for privacy and confidentiality is paramount. We adhere to strict policies to prevent discrimination or retaliation against those who engage in open conversations about compensation. However, employees privy to compensation information as part of their job role are expected to maintain confidentiality, except in specific circumstances outlined by law, such as during formal complaints, investigations, or as required by legal obligations.

Please note that Omnicell reserves the right to modify job roles and responsibilities as needed to meet our organization's evolving needs and drive our mission forward.