SUMMARY
The OSPS Credentialing and Audit Coordinator plays a key role in supporting the Client Services team by managing pharmacy credentialing activities, coordinating responses to PBM and third-party audits, and resolving payor-related issues. This role supports compliance, reimbursement optimization, and strategic initiatives across the organization.
ESSENTIAL FUNCTIONS
• Support the coordination and timely response to PBM and third-party audits, ensuring all requests are reviewed and addressed within required deadlines
• Prepare and organize audit responses and assist with appeal submissions when applicable
• Collect, review, and validate audit documentation from pharmacies to ensure accuracy and completeness prior to submission
• Assist with PBM-related activities, including MAC appeals, claim rejections, and reimbursement discrepancies
• Maintain active pharmacy credentialing with all required entities in compliance with regulatory and contractual requirements
• Communicate with PBMs to verify contracted reimbursement rates and initiate appeals as needed
• Maintain and audit contract and carrier code data within the third-party reconciliation system to ensure financial accuracy
• Manage and analyze the Daily Rejection Report and investigate and resolve third-party claim rejections
• Collaborate with Accounting, Finance, and Operations teams to support accurate reporting and resolution of audit findings and pricing discrepancies
• Support formal communications with Pharmacy Benefit Managers and Managed Care Organizations
• Perform additional duties as assigned to support departmental and organizational objectives
EDUCATION AND EXPERIENCE
Required Qualifications
• Certified Pharmacy Technician registration
• Minimum of 5 years of experience working in a specialty pharmacy environment
Preferred Qualifications
• 2 to 3 years of experience working in a pharmacy dispensing system
• Experience with PBM or payor audits
COMPETENCIES AND SKILLS
• Strong attention to detail with excellent organizational and time management skills
• Effective communication and interpersonal skills, including the ability to perform well in high-pressure situations
• Ability to manage multiple priorities in a fast-paced environment
• Strong analytical and problem-solving skills related to claims and reimbursement issues
• Proficiency in Microsoft Office applications
• Self-motivated, proactive, and resourceful with strong follow-through
• Ability to work independently and collaboratively within a team environment
• Professional demeanor with a strong work ethic and commitment to accuracy
• Ability to interact effectively with internal teams, clients, and external partners at all levels
• Ability to work remotely or in an office environment
• Willingness to travel up to 25% as needed
PAY RANGE
The targeted pay range for this position is $58,000 to $60,000 annually.
The final offer will be based on factors such as qualifications, experience, geographic location, and internal equity, and may vary within the stated range.
Since 1992, Omnicell has been committed to transforming pharmacy care through outcomes-centric innovation designed to optimize clinical and business outcomes across all settings of care. We strive to be the healthcare provider’s most trusted partner by our guiding promise of “Outcomes. Defined and Delivered.”
Our comprehensive portfolio of robotics, smart devices, intelligent software, and expert services is helping healthcare facilities worldwide to improve business and clinical outcomes as they move closer to the industry vision of the Autonomous Pharmacy.
Our guiding principles inform everything we do:
As Passionate Transformers, we find a better way to innovate relentlessly.
Being Mission Driven, we consistently deliver on our promises.
Our Entrepreneurial spirit makes the most of EVERY opportunity for innovation.
Understanding that Relationships Matter creates synergies that yield the greatest benefits for all.
Intellectually Curious, eager to think deeper to learn and improve.
In Doing the Right Thing, we lead by example in ALL we do.
We are deeply committed to Environmental, Social, and Governance (ESG) initiatives. Our ESG efforts focus on creating an inclusive culture and a healthier world. This includes our Employee Impact Groups, which foster inclusion and belonging, as well as our learning and well-being programs that support personal and professional growth. We also prioritize sustainability in our operations, aiming to reduce our environmental footprint and promote responsible business practices. Join us in transforming the pharmacy care delivery model, making patient care safer and smarter for all.
Omnicell is dedicated to fostering an inclusive workplace. We welcome applications from all individuals, valuing a wide range of perspectives and backgrounds. As an equal opportunity employer, we do not discriminate based on race, gender, religion, sexual orientation, gender identity, national origin, veteran status, or disability. We are committed to making our recruitment process accessible to everyone. We offer support and reasonable adjustments for individuals with disabilities during our hiring process. If you need assistance, please contact us at
[email protected].
At Omnicell, respect for privacy and confidentiality is paramount. We adhere to strict policies to prevent discrimination or retaliation against those who engage in open conversations about compensation. However, employees privy to compensation information as part of their job role are expected to maintain confidentiality, except in specific circumstances outlined by law, such as during formal complaints, investigations, or as required by legal obligations.
Please note that Omnicell reserves the right to modify job roles and responsibilities as needed to meet our organization's evolving needs and drive our mission forward.
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