Specialist, Contracting and Audit

Lumicera Health Services is seeking a Contracting and Audit Specialist to join our team!

The Contracting and Audit Specialist will assist with the business needs of the payer relations and contracting team which may include supporting proactive contracting compliance to prepare for and/or mitigate future audits, and respond to requested audits, prescription validations, and audit responses such appeals and requests for additional information. The primary responsibility of this position is to effectively manage all payer program compliance and responding to all payer requests. The Contracting and Audit Specialist will support and report to the Manager, Payer Contracts. The Contracting and Audit Specialist will support the Lumicera and all strategic partners that Lumicera provides shared services for to help meet strategic goals and mitigate financial losses from payers. The Contracting and Audit Specialist will interface with business leaders, pharmacists, legal, compliance, and external vendors with respect to specialty pharmacy services and audit duties.

Is this you? Find out more below!

How do I make an impact on my team?

Complete credentialing and new contract applications for vendors including payer and government clients
• Compile supporting documents and reports for payer applications, contracts, business reviews, audits, and ad hoc business requests
• Track agreements through the contracting process from reception to completion with both internal and external stakeholder input
• Re-enroll and re-credential existing payer and government plans. Monitor to proactively reenroll and resubmit to ensure no gaps in coverage
• Coordinate payer access roadmap for expanded payer contracts and investigate current networks where Lumicera and its partner pharmacies are not in network with
• Conduct internal testing, sampling, and auditing of operational and documentation processes to ensure compliance
• Analyze, compile, and prepare data analytics and presentations for payer clients
• Perform analyses and reports required for URAC, ACHC, and other accreditations as required. Assist with accreditation submissions as they pertain to evaluation and reporting
• Travel to meet with auditors and regulatory officials to meet audit and appeal standards
• Other duties as assigned

What our team expects from you?

• High School degree or equivalent required
• Bachelor's degree preferred
• Certified Pharmacy Technician preferred
• At least 5 years of pharmacy, payer, audit or similar experience
• Experience with Microsoft Excel, Word or equivalent is preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Lumicera?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

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