Audit Execution. 35%
- Lead and oversee pharma and client audits for Synergie.
- Support SOC audit evidence gathering for annual audit.
- Ensure audit work adheres to contractual standards and organizational policies.
- Evaluate the efficiency and effectiveness of internal controls, processes, and risk management frameworks.
- Coordinate with external auditors and participants to ensure alignment and minimize redundancy.
- Communicate with participants during pharma rebate audits and obtain evidence requested.
Risk Management and Compliance. 35%
- Collaborate with Finance, Legal, and IT to strengthen controls around invoicing.
- Monitor corrective action plans, ensuring timely resolution of audit findings. Advise on new business processes, system implementations, and policy changes from a risk perspective.
- Assist in development and manage invoicing and audit policies and procedure.
Leadership and Strategy. 30%
- Develop and execute the annual risk-based audit plan aligned with organizational strategy and regulatory requirements.
- Provide strategic direction and thought leadership for audit, risk management, and internal control programs.
- Partner with internal leaders to identify and mitigate emerging risks within invoicing and data governance of invoicing information.
- Present findings, insights, and progress updates to Invoicing & Audit management.
Requirements:
- Bachelor’s degree in business, healthcare, or other related field; Master’s degree preferred.
- 8+ years of work experience in a health care auditing role, with expertise in health plans, health systems, pharmacy, and managed care or specialty pharmacy. Must include at least 3 years of experience in medical and/or pharmacy drug management at a health plan or PBM.
- Strong experience managing external audit vendors during audits
- Strong understanding of audit practices
- Experience designing and executing audit programs.
- Strong data management and analytics skills with the ability to manage large data effectively.
- Strong knowledge of medical and pharmacy rebates, value-based contracts, and invoicing processes.
- Demonstrated ability to lead cross-functional teams, drive results in a fast-paced environment, and manage client support while ensuring alignment with Synergie’s objectives.
- Ability to develop relationships and influence with internal and external stakeholders
- Excellent leadership, communication and critical thinking skills and ability to anticipate issues and develop solutions.
- Must be eligible to work in the United States without need for work visa or residency sponsorship.
The compensation for this role is budgeted between $150,000 and $200,000.
#LI-Remote
This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Skills Required
- Bachelor's degree in business, healthcare, or related field; Master's degree preferred.
- 8+ years of work experience in a health care auditing role.
- At least 3 years of experience in medical and/or pharmacy drug management.
- Strong experience managing external audit vendors.
- Strong understanding of audit practices.
- Experience designing and executing audit programs.
- Strong data management and analytics skills.
- Strong knowledge of medical and pharmacy rebates and invoicing processes.
- Demonstrated ability to lead cross-functional teams.
- Excellent leadership, communication, and critical thinking skills.
What We Do
Blue Cross Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Index.
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