[Hiring] Biologics Payer Audit and Accreditation Specialist @McKesson

Role Description

The Biologics Payer Audit & Accreditation Specialist supports two closely related compliance functions within Biologics by McKesson: PBM/payer audit management and specialty pharmacy accreditation. This role is intentionally designed to be flexible. The successful candidate will bring demonstrated depth in either PBM audit management or specialty pharmacy accreditation, and will develop working proficiency in the second discipline through structured onboarding and mentorship from the respective functional owners.

On the audit side, the Specialist supports the intake, tracking, research, and response of PBM audit requests (including desk, field, real-time, and prescription validation reviews), assists in the preparation of audit appeals, and helps identify operational and documentation gaps that create recoupment risk. On the accreditation side, the Specialist supports the maintenance of URAC and ACHC accreditation across Biologics sites, including:

• Policy and SOP review
• Evidence collection and submission
• Performance measure reporting
• RFI response coordination
• Survey readiness activities

This position requires working knowledge of specialty pharmacy operations, pharmacy claims adjudication, PBM provider manuals and state pharmacy audit regulations, and/or accreditation standards and evidence requirements. This position requires excellent written and verbal communication, strong documentation discipline, attention to detail, and consistent follow-up. This is a work-from-home position with approximately 15% travel.

Qualifications

• 4-year undergraduate college degree preferred; an equivalent combination of education and directly relevant experience will be considered.
• Certified Pharmacy Technician (CPhT) preferred.

Requirements

• Degree or equivalent and typically requires 4+ years of relevant experience.
• 4+ years of combined experience in specialty pharmacy, pharmacy operations, PBM, or pharmacy regulatory and payer compliance.
• At least one of the following:
  • 2+ years of PBM audit management and/or PBM auditor experience, including audit response, appeals, and recoupment defense; OR
  • 2+ years of specialty pharmacy accreditation experience (URAC and/or ACHC), including standards interpretation, evidence submission, and survey support.
• Working knowledge of pharmacy claims adjudication, claim rejections, and associated resolutions.
• Demonstrated experience maintaining structured documentation, traceability, and corrective action follow-through.
• Knowledge of pharmacy systems, pharmacy operations, and pharmacy workflow.

Benefits

• Competitive compensation package.
• Base pay range: $79,600 - $132,600.
• Other compensation, such as an annual bonus or long-term incentive opportunities may be offered.

Expected Competencies

• Detail-oriented with strong documentation and organizational discipline.
• Able to communicate effectively with pharmacists, pharmacy staff, operations leaders, auditors, and surveyors.
• Good problem-solving and decision-making skills.
• Strong interpersonal and written communication skills.
• Self-motivated and results-oriented; requires limited direction or direct supervision.
• Effectively manages multiple workstreams with competing deadlines.
• Team player with the ability to manage timelines and goals.
• Strong analytical skills.
• Ability to operate in a fast-paced, dynamic, regulated business environment.
• Proficient in Microsoft Office; technologically savvy.

Working Conditions

• General office environment; Work From Home.
• Approximately 15% travel, including travel to Biologics sites for survey support, mock audits, and readiness activities.