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POSITION SUMMARYThis position will report to the Network Manager and will be responsible to oversee and manage all matters related to pharmacy network audits.ROLES AND RESPONSIBILITIES• Responsible for the supervision of the Pharmacy Network Audit and FWA program.• Conducts quality reviews on tasks, audits and pricing reviews performed by the team.• Keeps up to date of any new generic in the market.• Examine documents to verify required compliance, completeness, and accuracy of data.• Confer with document originator and approvers to resolve identified discrepancies.• Control document databases, and corresponding files.• Generate communication to the appropriate personal on new and revised documents.• Maintain computer database of all documentation that will allow secure document retention and timely retrieval.• Adheres to all HIPAA guidelines/regulations.• Follow company policies and procedures.• Performs an impact analysis for each client based on PharmPix’s client utilization data, as stipulated in departmental policies and procedures.• Develops audit plans and approaches, including scoping special audits.• Identifies and coordinates assignments within the teams.• Performs management duties including, but not limited to, performance management, staff development, coaching, training, staffing, disciplinary action, performance standards, and goals and objectives.• Participation in the Credentialing Committee.• Reviews processes and identifies opportunities to automate and develop efficiencies.• Prepares monthly, quarterly, yearly and ad hoc reports to summarize audit findings.• Presents quarterly and yearly audit results to customers.• Maintains professional affiliations and enhances professional development to keep current in the latest healthcare trends and developments.• Stays up to date on new laws and regulations related to pharmacy audits.• Ensures all deadlines for audits reviews are met in an efficient manner.• Supports all Quality Management Program initiatives.• Other projects and duties are assigned by the Operations Manager or President.TRAINING & EDUCATION• B.S. from an Accredited University and Pharmacy Technician Degree.LICENSURE / CERTIFICATION• Puerto Rico Board of Pharmacy Technician Certification in Good StandingPROFESSIONAL EXPERIENCE• At least 5 years prior experience in a pharmacy related business.PROFESSIONAL COMPETENCIES / SKILLS• Ability to manage people and provide team leadership.• Ability to organize and integrate organizational priorities and deadlines.• Ability to develop and maintain productive relationships with other internal departments, PhamPix clients and other health care professionals.• Ability to establish and maintain quality control standards.• Ability to work independently or as part of a team.• Skill in exercising a high degree of initiative, judgment, discretion and decision-making to achieve organizational objectives.• Strong analytical and decision-making skills.• Knowledge of federal and the Commonwealth of Puerto Rico health care delivery and pharmacy regulations/regulatory agencies.• A thorough comprehension of Medicare Part D rules and regulations.• Knowledge of the rules and regulations promulgated by the Insurance Commissioner Office of the Commonwealth of Puerto Rico.• Demonstrated effective organizational and communication skills.• Strong verbal and written communications skills• Knowledge of Microsoft applications.• Fully bilingual English and Spanish.PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans