Position Purpose

The Managed Care Contracting (MCC) Department services more than 300 contracted third-party entities that service over 1700 pharmacies.  These entities can audit our claim submissions for accuracy and compliance with contracts, which can result in recoupment of reimbursement that was previously paid to pharmacies.

The Manager of Third Party Audits is responsible for overseeing all audits activity at Albertsons, including but not limited to managing our end-to end audit response process, overseeing the day-to-day operations of the audits team, leading audit appeals activity, and developing and implementing strategies to minimize audit risk and recoupment.  Additionally, the Manager of Third Party Audits will ensure that audit prevention and mitigation is considered and prioritized in all cross-functional initiatives including, but not limited to, system enhancements and editing, operational process, managed care contracting, and service development.  The Manager of Third Party Audits plays a vital role in protecting pharmacy profitability and ensuring financial viability of the pharmacy business.

Key Accountabilities

• Audit Responses

• Ensure complete and accurate responses provided on all received audits, including collaborative work with pharmacies to assist with proper documentation and other mitigation measures to minimize recoupments

• Aggressively pursue all available appeals and escalation process to contest recoupments where appropriate

• Ensure that work is distributed throughout the team in an appropriate manner and that all members of the team are cross-trained in all parts of the audits response process

• Audit Strategy and Recoupment Mitigation

• Review audit results to identify audit trends and opportunities, track audit performance, evaluate efficacy of active recoupment mitigation strategies, and develop new recoupment mitigation strategies

• Collaboratively work with cross-functional partners to develop and deploy recoupment mitigation strategies and tactics, including but not limited to system enhancements, claim submission editing, targeted educational content, and process redesign

• People Leadership

• Manage, lead, and support the audits team in daily activities as well as strategic initiatives

• Ensure all team members are trained to perform at the highest possible level of their abilities

• Develop team members to be prepared to take on additional responsibilities as opportunities arise and to succession plan for the department

• Lead cross-functional counterparts through influence to achieve audit priorities within the initiatives of other departments

• Communication

• Summarize and communicate audit results and trends to pharmacies, Pharmacy District Managers, Directors of Pharmacy Operations, and Vice Presidents of Pharmacy Operations

• Effectively develop and communicate processes designed to minimize audit risk to pharmacies

• Act as a communication bridge between Third Party Audits, Managed Care, FP&A, and other cross-functional teams

• Relationship Management Support

• Develop and maintain collaborative relationships with audit counterparts at PBMs and Plans to facilitate support of appeals and recoupment defense, issue escalations, and process change where feasible

• Develop and maintain collaborative relationships with industry counterparts to learn best practices and understand industry wide trends

Required Knowledge and Experience

• Bachelor’s degree or equivalent work experience

• 5+ years of experience in retail pharmacy, managed care, and/or pharmacy audits

• 2+ years of experience managing people and working collaboratively with a cross-functional team

• Deep understanding of pharmacy workflow, prescription processing and billing, and pharmacy mathematical calculations

• Knowledgeable regarding pharmacy federal and state laws

• Ability to analyze trends and communicate findings effectively

• Strong problem solving and strategic thinking skills

• Excellent verbal and written communication skills

• Ability to work effectively in a fast-paced, cross-functional team environment

• Strong independent work ethic and confidentiality management

• Proficiency in Microsoft Office, including Excel, Outlook, and Word

Preferred Knowledge and Experience

• Graduate from an Americal Council of Pharmaceutical Education Accredited College of Pharmacy with active pharmacist licensure

Travel Requirements

• 5–10% travel may be required

Physical Environment

• Work is primarily performed in a temperature-controlled office environment

• May sit for extended periods at a desk or computer

• Use of calculators, keyboards, telephones, and other office equipment is routine

• Occasional stooping, bending, twisting, and reaching may be required

Starting rates will be no less than the local minimum wage and may vary based on criteria such as location, experience, and qualifications. Candidates with unique qualifications may be considered for compensation above this range. Benefits may include medical, dental, vision, disability and life insurance, sick pay, PTO/Vacation Pay or Flexible Time Off, paid holidays, bereavement pay, and retirement benefits (pension and/or 401k eligibility). Associates in this position may be eligible for a quarterly bonus.