Payer Audit Manager

Job Description

Job Description

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do.

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.

We are seeking team members who :

Are inspired and compassionate problem solvers;

Produce high quality work;

Thrive in the excitement of the ever-challenging environment of modern medicine; and

Are committed to achieving superior health outcomes for people living with rare and devastating diseases.

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.

Join the PANTHERx team, and define your own RxARE future in healthcare!

Location : Pittsburgh, PA (Hybrid or Remote)

Classification : Exempt

Status : Full-time

Reports to : Senior Director, Quality and Compliance

Purpose

The Payer Audit Manager is responsible for overseeing all third-party payer audits for PANTHERx™ Rare Pharmacy. This critical role ensures compliance with contractual and regulatory requirements by managing payer audit processes end-to-end. The position requires exceptional attention to detail, strong collaboration across multiple departments, and a deep understanding of pharmacy claim data and related documentation. The Payer Audit Manager serves as the primary liaison with external auditors, fostering positive relationships to facilitate efficient and accurate audit outcomes.

Responsibilities

• Ensures timely and accurate preparation and submission of all audit documentation to meet established deadlines.
• Tracks and manages all audit timelines and deliverables to guarantee compliance and avoid penalties.
• Compiles and validates all data required for audits, including pharmacy claim information, REMS program documentation, and other operational records.
• Conducts a thorough first-level review of audit documentation for completeness and accuracy.
• Collaborates closely with Pharmacy Operations, Compliance, and other internal teams to gather and verify required information.
• Prepares for state inspections and accreditation audits as needed.
• Develops and maintains quality assurance reports related to audit activities.
• Act as the primary point of contact for third-party auditors, managing communications professionally and effectively.
• Handles audit appeals, grievances, and reconsideration requests in accordance with payor requirements.
• Communicates audit trends, issues, and risks to leadership promptly.
• Creates educational materials, such as audit tips and job aids, to support internal teams.
• Conducts mock audits and readiness checks to ensure operational preparedness.
• Builds and maintains strong relationships with external auditors to promote collaboration and minimize friction during audits.
• Performs additional projects and tasks as assigned.

Required Qualifications

Preferred Qualifications

Work Environment

This position operates in a home or professional office environment. Standard office equipment such as computers, phones, and photocopiers will be used.

Physical Demands

While performing the duties of this job, the employee is regularly required to see, talk, or hear. The employee frequently is required to sit; stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Visual acuity is necessary for tasks such as reading, observing surroundings, or working with various forms of data. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

Benefits :

Hybrid, remote and flexible on-site work schedules are available, based on the position. PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short / long term disability coverage, and an Employee Assistance Program! Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees. Of course we offer paid holidays too!

Equal Opportunity :

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.