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Opportunity Snapshot

If you've dipped your toe in the pharmacy audit pool and are looking to advance your competencies and fully immerse yourself in all aspects of pharmacy operations, this is the perfect time to join HMS, 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.

Joining our MIC audit team in Irving, you will divide your focus between conducting on-site reviews (50%) and desk-based audits (50%) for various pharmacy clients throughout the U.S (mostly based in Texas, Arkansas and California). To be a good fit for this opportunity you will bring hands-on knowledge of retail and/or hospital, home infusion, mail service, specialty drug or long-term care pharmacy operations along with a solid understanding of state board pharmacy laws and regulations.

In addition to your pharmacy auditing expertise, you will also be able to hold your own ground with pharmacy staff, exuding a polished demeanor and compelling confidence as you strive to develop strong working relationships with a variety of clients. While you'll enjoy a fair amount of work-life balance (this is mostly an 8-5 job as opposed to standing on your feet in a retail pharmacy environment), we will expect you to bring a "can do" attitude as you produce high-quality audit work in a dynamic setting.

Since 1985 HMS has focused exclusively on the healthcare industry; since then we have 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. In spite of the economic downturn, healthcare has proven to be a recession resilient sector and we have posted 18% growth year over year since 2001. Yet we still maintain an entrepreneurial small-company culture in which individuals can make a difference and shape their own career trajectories.

What Else You'll Bring to the Table

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

• Licensed Pharmacy Professional RPh./Pharm.D.
• 3-4 years of pharmacy experience; ideal candidate will have worked in the field in a pharmacy setting.
• Analytical ability to collect multiple sources of data and draw logical conclusions.
• Impeccable 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 50%) nationwide.

Preferred, but not required:

• Knowledge of third party parameter programs.
• Knowledge of PBM operations.
• Knowledge of CMS initiatives and requirements.

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 this initiative as you audit assigned pharmacies and make your mark in short order.
• Variety & skill development -- you'll be exposed to every facet 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.
• Ample room for growth -- you will be well positioned to transition into a variety of career growth opportunities based on your ambition and aptitude.
• Autonomy & empowerment -- we'll entrust you with the freedom and flexibility to achieve your objectives independently with significant latitude for initiative and independent judgment.
• A culture of growth and transition -- we are positioned for explosive growth-- both organically and via acquisitionbut 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.

More About Your Role

This is an individual contributor role and you'll report directly to the Vice President of Operations as you join us at our Irving office.

As you come on board, you'll receive comprehensive training in California or Texas and after a 2-3 week period, we'll expect you to really understand our auditing process and begin making a real impact.

Our field audits typically span anywhere from half a day to a week and while you'll be actively working on one pharmacy audit/day, you may juggle 10-20 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:

• Conduct all aspects of audits to fulfill the CMS MIC requirements.
• Conduct all aspects of On-Site Reviews (OSR) for various pharmacy clients.
• Conduct forensic claims analysis for pharmacy selection.
• Identify potential fraudulent activity through claims analysis.
• Analyze and interpret on-site audit results to determine final recommendations to clients.
• Attend client meetings, as required, to discuss any aspects of on-site reviews.
• Create detailed written reports containing audit findings.
• Research and interpret State Board of Pharmacy Laws.
• Research State Audit Bill of Rights requirements as they pertain to on-site audits.
• Perform Focused Investigation Audits as needed/requested.
• Provide support to Central Script Review (CSR) Department.
• Perform any other tasks as assigned by VP of Operations.

Keys to Success

Pivotal to your success in this role is 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.

We are an equal opportunity employer. EOE M/F/D/V

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