Pharmacy Subject Matter Expert - Fraud (1062-852)

Delmarva Foundation Baltimore , MD 21203

Posted 1 week ago

Qlarant, Inc., is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country.

Qlarant's Investigations MEDIC contract has an immediate opening for a Pharmacy Subject Matter Expert. This is a mid-level professional position that does not require a Pharmacist license. It's a perfect position for an experienced Pharmacy Tech with expertise in Medicare Part D, inventory management, and fraud investigation / pharmacy audit. As a member of our Investigative MEDIC team, you will work in concert with our pharmacists, data analysts and investigators to detect and prevent fraud, waste and abuse in the Medicare Part C and Part D programs.

This position could be based in our Baltimore, MD office or home-based in most areas of the country for well qualified candidates.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

  • Collaborates with the customer to design and adapt processes and deliverables to meet changing needs.

  • Provides relevant pharmacy data and billing training to Analysts and Investigators.

  • Serves as subject matter expert to internal and external investigators on pharmacy processes, ordering, and billing.

  • Assists in the development, evaluation process, and implementation of policies, procedures, and training/education modules relating to pharmacy team deliverables.

  • Participates in targeted/strike force reviews and intelligence targeting. Assists data teams in regards to pharmacy data.

  • Interfaces significantly with internal investigators and external law enforcement personnel.

  • Supports ongoing customer relationships and development of new initiatives.

  • Assists pharmacy team in ensuring contract work is delivered timely and meets quality standards.

  • May assist in the implementation of new contracts and responds to RFP process as needed.

  • Identifies opportunities for improvement; assists teams in developing and implementing improvement strategies.

Required Skills

To perform the job successfully, an individual should demonstrate the following competencies:

  • Analytical
  • Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
  • Problem Solving
  • Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations.
  • Project Management
  • Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
  • Customer Service
  • Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
  • Delegation
  • Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities.
  • Quality Management
  • Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
  • Business Acumen
  • Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.
  • Organizational Support
  • Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities.
  • Judgment
  • Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
  • Planning/Organizing
  • Prioritizes and plans work activities; Plans for additional resources; Sets goals and objectives; Develops realistic action plans.

Required Experience

  • Bachelor's degree in a relevant field preferred, extensive experience in the field; or equivalent combination of education and experience.

  • Must possess the ability to interact with all levels of personnel.

  • Registered or Certified Pharmacy Technician required.

  • Three years or more pharmacy experience, with inventory management experience preferred.

  • Medicare Part D experience preferred.

  • Fraud investigation and/or pharmacy audit experience preferred.

  • Intermediate to advanced knowledge of Excel preferred.

  • Data analytics experience preferred.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.


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Pharmacy Subject Matter Expert - Fraud (1062-852)

Delmarva Foundation