Biologics Payer Audit and Accreditation Specialist

Overview

Supports PBM/payer audit management and specialty pharmacy accreditation for Biologics by McKesson. The role coordinates audit responses, accreditation evidence, compliance documentation, and quality improvement activities.

What you'll do

• Track and coordinate PBM audit requests and response deadlines.
• Research audit findings and prepare responses and appeals.
• Analyze discrepancy trends and identify recoupment risks.
• Maintain audit trackers, dashboards, and reporting.
• Coordinate URAC and ACHC accreditation evidence and submissions.
• Support survey readiness, mock audits, corrective actions, and CAPA tracking.
• Prepare compliance reports, presentations, education materials, and job aids.

What you'll need

• 4+ years of relevant experience or an equivalent combination of education and experience.
• 4+ years in specialty pharmacy, pharmacy operations, PBM, or pharmacy regulatory and payer compliance.
• 2+ years of PBM audit management or auditing experience, or 2+ years of specialty pharmacy accreditation experience.
• Working knowledge of pharmacy claims adjudication, claim rejections, and resolutions.
• Experience maintaining structured documentation, traceability, and corrective action follow-through.
• Knowledge of pharmacy systems, operations, and workflows.
• Strong communication, analytical, organizational, and documentation skills.

Nice to have

• Four-year undergraduate degree.
• Certified Pharmacy Technician certification.
• Experience with AccrediNet, MasterControl, Power BI, Excel, or pharmacy management systems.
• Community oncology, rare disease, or limited distribution drug experience.

Details

• Work from home.
• Approximately 15% travel to Biologics sites.
• Base pay range: $79,600-$132,600 yearly.