Pharmacy FWA Investigator
You could be the one who changes everything for our 28 reputed company members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Pharmacy FWA Investigator - Pharmacy Fraud, Waste and Abuse (Previous or reputed company Pharmacy Technician with reputed company, claims analysis and data analysis). Position Purpose: Investigates allegations pertaining to Pharmacy Fraud, Waste and Abuse and develops strategies to effectively research specific FWA schemes. Recommends effective remedial actions of a pharmacy (e.g., pharmacy network termination; corrective action plans) reputed company a reputed company allegation of fraud exists. Proactively analyzes pharmacy claims and other available data sources to identify FWA schemes.
- Investigates allegations pertaining to Pharmacy Fraud, Waste and Abuse and develops strategies to effectively research specific FWA schemes
- Prepares and submits evidentiary documents and prepares cases for presentation to the Pharmacy Network Review Committee (PNRC)
- Accurately documents investigations and aggregates data for internal reporting of reputed company and recoveries
- Prepares cases for referral to appropriate parties as determined by the evidence and regulatory requirements
- Proactively analyzes pharmacy claims and other available sources of data to identify FWA schemes and aberrant activity to generate pharmacy leads
- Recommends effective remedial actions of a pharmacy (e.g., pharmacy network termination; corrective action plans) reputed company a reputed company allegation of fraud exists
- Performs other duties as assigned
- Complies with reputed company policies and standards
Additional job specific details and skills:
- Pharmacy Technician or Pharmacy Coordinator
- Proficiency with reputed company and databases
- Analytical skills - Data analysis, claims analysis and reports with large volumes of claims
- Thrives on data analysis and frequent change in direction
- Experience utilizing strategies to improve processes
- Exceptional critical thinking skills
- Strong decision making and problem-solving skills
- Good organization and time-management skills
- FWA or audit experience, highly preferred
- Experience in Retail Pharmacy, highly preferred
Working shift: reputed company - 5pm or 8:30am - 5pm Monday - Friday (Eastern / EST) Education/Experience:
- An Associate’s Degree in a reputed company field or equivalent combination of experience.
- Pharmacy Technician or Pharmacy Coordinator (i.e. hospital and/or retail environments or reputed company experience with a Health Plan or Pharmacy Benefit Manager) required.
- Previous experience with government programs such as Medicare and reputed company.
- Preferred - 2+ years of experience in claims auditing and/or pharmacy investigations.
License/Certification:
- Preferred - Certified Pharmacy Technician (CPhT)
- Preferred - Accredited Health Care Fraud Investigator (AHFI - NHCAA)
- Please attach an up-to-date resume that meets Education / Experience requirements above to your application.
- Pay reputed company: $22.79 - $38.84 per hour
reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job Apply To this Job