Biologics Payer Audit and Accreditation Specialist
Core
Supports PBM/payer audit management and specialty pharmacy accreditation compliance for biologics sites.
Role type
Specialist in pharmacy compliance and accreditation
Builds
Audit responses, appeals, accreditation evidence, and quality improvement reports
Domain
Healthcare / Specialty Pharmacy / Regulatory Compliance
Deliverable
dashboards & analysis
Required skills
PBM audit management, specialty pharmacy accreditation (URAC/ACHC), pharmacy claims adjudication, state pharmacy audit statutes, documentation discipline, stakeholder coordination
Preferred skills
Certified Pharmacy Technician (CPhT), accreditation management platforms (AccrediNet), document control systems (MasterControl), pharmacy management systems, Power BI, Excel, community oncology experience
Technologies
AccrediNet, MasterControl, Power BI, Excel, Microsoft Office
Responsibilities
Intake and response of PBM audit requests; research audit findings and draft appeals; maintain audit trackers and dashboards; support URAC and ACHC accreditation maintenance and survey readiness; coordinate evidence collection and performance measure reporting; develop staff education on audit readiness
Seniority
Mid-level, hands-on IC
