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Director, PBM Contract Audit

Remote US Based

For over 30 years PSG has been singularly focused on helping our clients navigate the complex and ever-changing challenges of drug management. Through our leading pharmacy intelligence and technologies, we save our clients billions of dollars every year with an unwavering commitment to serving as your advocate and strategic partner. PSG has market leading technology and administration services for hospitals and health systems.

Our mission is to relentlessly advocate for our clients as we partner together to develop innovative drug management solutions that deliver exceptional strategic insights, financial and clinical value.

The Director of Audit Services will be responsible for establishing strategic direction and for the leadership, development, and production of PSG audit services. The Director will understand the business needs of our clients and create audit solutions for clients from all PSG client market segments:  Employer, Labor, Hospital and Health Plan (including those programs dictated by participation in government programs, e.g. Medicaid and Medicare D).  The Director works with all levels of management within PSG and with PSG clients providing industry expertise and insight related to best practices for pharmacy program audit services. The Director oversees the development of audit work plans, tools, and methodologies and for the execution of financial, operational and compliance audits specific to pharmacy management services on behalf of PSG clients.  The Director will be someone that is self-directed and thrives in managing timelines in a fast-paced environment.  A high attention to detail and process will be critical for success. Experience and comfort working with clients and vendors is a must as this role will require interaction with various stakeholders, including those in executive-level positions.

Scope of work:

  • Managing timelines and deliverables of the team in a fast-paced environment
  • Manage & Mentor team of seasoned auditors
  • Prepares and executes a resource capacity plan and resource schedules
  • Support audit business development opportunities and marketing content
  • Establish and maintain key relationships with internal executives and external stakeholders (clients and vendors)
  • Subject matter expert with deep understanding and knowledge of PBM contracts and terms
  • Utilize PSG’s proprietary Compliance Model
  • Document all potential issues and track decisions including escalations
  • Collaborate with account management and pharmacy consultants to discuss and present results with clients and vendors
  • Work with IT to further develop Compliance Model logic and capabilities
  • Assist in other financial projects as needed

Qualifications

  • Bachelor’s degree in Business, Finance, or a health-related field
  • 5 years of leadership experience
  • At least 7 years of either a) pharmacy benefit audit or b) claim adjudication research experience on one or more PBM platforms
  • Working knowledge of the PBM industry and pharmacy benefit claims
  • Proficient in Microsoft Office, with extensive experience working with Excel
  • Proficient in SQL to extract data and build queries
  • Ability to effectively develop and maintain strong working relationships with internal and external stakeholders
  • Strong written and verbal communication skills and discipline to multitask and prioritize projects to meet scheduled deadlines
  • Strong analytical, problem-solving, organization, critical thinking, and time management skills
  • Excellent attention to detail and quality
  • Previous Medicare Part D experience preferred
  • Ability to interact with diverse group of stakeholders including executives, managers, clients, and subject matter experts both technical and non-technical
  • Solid, independent worker (work from home)
  • Ability for some travel (5% - 10%)

COMPENSATION:

The national average salary for this role is $140,000 to $180,000 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on your experience, skills, training, certifications and education, while also considering internal equity and market data.

 

WHY EPIC: 

EPIC has over 60 offices and 3,000 employees nationwide – and we’re growing! It’s a great time to join the team and be a part of this growth. We offer:

  • Generous Paid Time off
    • Managed PTO for salaried/exempt employees (personal time off without accruals or caps); 22 PTO days starting out for hourly/non-exempt employees; 12 company-observed paid holidays; 4 early-close days
  • Generous leave time options: Paid parental leave, pregnancy disability and bonding leave, and organ donor/bone marrow donor leave
  • Generous employee referral bonus program of $1,500 per hired referral
  • Employee recognition programs for demonstrating EPIC’s values plus additional employee recognition awards and programs (and trips!)
  • Employee Resource Groups: Women’s Coalition, EPIC Veterans Group
  • Professional growth & development: Mentorship Program, Tuition Reimbursement Program, Leadership Development
  • Unique benefits such as Pet Insurance, Cancer Insurance, Identity Theft & Fraud Protection Coverage, Legal Planning, Family Planning, and Menopause & Midlife Support
  • Additional benefits include (but are not limited to): 401(k) matching, medical insurance, dental insurance, vision insurance, and wellness & employee assistance programs
  • 50/50 Work Culture: EPIC fosters a 50/50 culture between producers and the rest of the business, supporting collaboration, teamwork, and an inclusive work environment. It takes both production and service to be EPIC!
  • EPIC Gives Back – Some of our charitable efforts include Donation Connection, Employee Assistance Fund, and People First Foundation
  • We’re in the top 10 of property/casualty agencies according to “Insurance Journal”

To learn more about EPIC, visit our Careers Page: https://www.epicbrokers.com/about/epic-careers/. 

EPIC embraces diversity in all its various forms—whether it be diversity of thought, background, race, religion, gender, skills or experience. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard. It is our belief that diversity drives innovation and that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients. 

California Applicants - View your privacy rights at: https://www.epicbrokers.com/wp-content/uploads/2025/01/epic-ca-employee-privacy-notice.pdf. 

 

#LI-MS2

#PSG

#LI-Remote

 

 

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