Opportunity Snapshot

This multifaceted role will allow you to showcase: a) your analytical prowess and b) your communication polish as you drive a variety of desk-based pharmacy audits and field calls.

HMS is a company rich with opportunity; not only are we the undisputed industry leader in coordination of benefits & program integrity services for government healthcare programs, but with Medicaid spending projected to double in ten years, we are uniquely poised to capitalize on this billion dollar market. And we were ranked #3 on Fortune's 2009 FSB 100 list of America's fastest growing small public companies.

As an Auditor, you will spend about 70% of your time analyzing and interpreting pharmacy prescriptions and other supporting documents to determine audit outcomes, and the remaining 30% with phone-based support. To be a good fit for this opportunity you will bring hands-on knowledge of one of the following: PBM, retail, hospital, home infusion, mail service, specialty drug and/or long-term care pharmacy operations along with a solid understanding of state board pharmacy laws and regulations. You'll showcase good phone etiquette as you patiently assist pharmacists with questions over the phone and strive to develop strong working relationships with a variety of pharmacy clients.

What Else You'll Bring to the Table

In addition to the qualifications detailed above, you'll need:

• Licensed Pharmacy Technician, CPhT is preferred.
• Minimum 4 years of pharmacy experience; hospital pharmacy experience is a plus.
• Analytical ability to collect multiple sources of data and draw logical conclusions.
• Previous fraud, waste, and abuse data mining experience.
• Strong communication skills, including active listening and in presenting findings and recommendations.
• Solid computer proficiency in a Microsoft Office environment, including Word, Excel and Access.
• Ability to travel (approximately 5%) nationwide.
• Knowledge of CMS initiatives and requirements is a plus.
• Certified fraud examiner preferred.

What's in It for You

• Right time, right place to make an impact -- with billions of dollars at stake, HMS is committed to ensuring that all our operations comply with both the spirit and the letter of government regulations; you'll play a key role in fighting healthcare fraud as you audit assigned pharmacies and make your mark in short order.
• Variety & skill development -- you'll be exposed to a variety of pharmacy operations (ranging from clinical to administrative) and will develop your technical knowledge, data mining expertise, and other skills that will assist you throughout your career.
• Optimal work-life balance -- this is mostly an 8-5 job as opposed to standing on your feet for long hours in a retail pharmacy environment. And you'll actually get to enjoy holidays and weekends with your family.
• A culture of growth and transition -- we are positioned for explosive growth both organically and via acquisition, but are also proactive about maintaining a culture in which employee input is welcome, initiative is encouraged, and excellence and innovation are highly valued.
• Excellent benefits -- in addition to a competitive salary, we offer a comprehensive benefits package that includes a 401(k) plan with generous employer match, flexible spending plans, and much more.

Role Specifics

This is an individual contributor role and you'll report directly to the Director of Pharmacy Operations, West as you join the on-site review audit team of eight at our Culver City office.

You will juggle a number of audits in various stages of completion. As with any auditing position, you will aim to meet and exceed your targets as you drive to results and show off your multitasking prowess to effectively prioritize and complete work within stringent deadlines.

In general, your responsibilities are to:

• Review pharmacy and desk audit findings as needed.
• Review, analyze and interpret prescription documents.
• Conduct analytics to identify potential fraudulent activity.
• Based on analytics, determine letter recipients.
• Initiate and record all inbound and outbound results of letters.
• Create detailed written reports containing audit findings.
• Communicate findings with management and clients.
• Research and interpret State Board of Pharmacy Laws and initiatives related to Centers for Medicaid and Medicare Services (CMS).
• Maintain complete and accurate documentation of all audit related information, reports and conversations.

Keys to Success

Pivotal to your success in this role will be your ability to take a proactive and innovative approach to the pharmacy audit function by building strong relationships and maintaining high levels of communication with all stakeholders. You will balance a consultative, problem-solving style with an engaging, entrepreneurial drive.

You will independently manage your audits, maintaining a big-picture focus while keeping a razor-sharp handle on day-to-day details and employing sound judgment to develop accurate assessments and recommendations. And finally, you'll continually evaluate our systems and processes to identify improvements and drive best practices to sustain our growth objectives.

If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!

Who We Are

Health Management Systems has always been focused exclusively on the healthcare industry. In 1985, we began providing third party liability identification and recovery services to our first Medicaid agency client. Since then, we've partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars and save billions more through cost avoidance.

We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.