Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Client Audit Specialist-RemoteJob Description

As a member of the Client Audit Management (CAM) team, the Client Audit Specialist is accountable for independently, or in collaboration with senior staff or compliance leader, managing regulatory and/or client-initiated audits. The Specialist is responsible for evaluating and understanding the purpose of various audit types and the related deliverables, developing a holistic understanding of the audit management process, and managing the end-to-end audit activities. This position seeks and obtains additional expertise as indicated from respective Compliance and Operational subject matter experts to meet applicable regulatory, client, and/or functional audit expectations.

Responsibilities

Review and interpret assigned audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit requestPresent sample cases or evidence data for assigned processes and act as a subject matter expert for business requirements, system specification, process flows, process change, Federal and/or State regulations and/or accreditation standards implicationsDevelop and maintain key internal and external stakeholder relationships to effectively provide audit consultation, streamline work activity, create/drive efficiencies, and ensure consistent, timely, and accurate audit completion, reporting, or submission of deliverablesMonitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to Audit Advisors, department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findingsPerform quality reviews and analysis of audit deliverables to ensure compliance with contractual and regulatory requirementsEnsure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changesEnsure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholdersIntegrate project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, throughout the entire auditSupport department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintainedOther duties as assigned

Education & Experience

Bachelor's degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required2 years of relevant work experience in audit, compliance or operations within a regulated environmentMust be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Effective verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefingsStrong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entitiesDemonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathyOrganization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising qualityAgility and adaptability to change and navigate in a demanding, dynamic, fast-paced, intense, and matrix environmentAbility to use independent judgment and critical decision making in the analysis of audit processes and evidenceIntermediate to Advanced skills in Microsoft Office Suite (Word, Excel)

Preferred Qualifications

Health insurance/PBM operations and/or contract audit experienceExperience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefitProject management experience

Physical Demands

Minimal travel may be requiredAbility to work a flexible schedule outside of Prime's core business hours to occasionally accommodate different time zones and during critical client auditsConstantly required to sit, use hands to handle or feel, talk and hearFrequently required to reach with hands and armsOccasionally required to stand, walk and stoop, kneel, and crouchOccasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 poundsSpecific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focusEvery employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.