Biologics Payer Audit and Accreditation Specialist

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve – we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow’s health today, we want to hear from you. Role Overview 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, and survey readiness activities. The 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. Key Responsibilities The weighting below reflects the expected steady-state distribution of work. Assignment weighting may flex based on the incumbent's background, business need, and accreditation or audit cycle timing. PBM / Payer Audit Support and Risk Mitigation Supports intake, logging, tracking, and timely response of PBM audit requests across all Biologics sites, ensuring adherence to contractual and regulatory response deadlines. Researches audit findings, gathers supporting documentation, and drafts audit responses and appeals under the direction of the audit function owner. Assists in the analysis of audit findings and discrepancy trends by payer, site, drug, and discrepancy type to identify recurring root causes. Maintains audit trackers, dashboards, and reporting to support visibility for Operations, Quality, Finance, and Legal stakeholders. Supports interpretation and application of state pharmacy audit statutes, PBM provider manual terms, and contractual audit limitations. Partners with Operations to recommend workflow and documentation changes that reduce audit exposure and recoupment risk. Accreditation and Continuous Quality Improvement Supports URAC and ACHC accreditation maintenance, renewal application submission, and ongoing standards compliance across accredited sites. Assists with gap analysis between current-state policies, SOPs, and operational practice versus applicable accreditation standards. Coordinates and uploads accreditation evidence, tracks required performance measure reporting, and supports RFI response development and submission. Supports survey readiness activities, including mock audits, staff readiness materials, documentation review, and follow-up on corrective actions. Assists with maintenance of accreditation documentation repositories, licensure and credentialing records, and version control. Supports continuous quality improvement initiatives, including quality improvement projects, corrective and preventive action (CAPA) tracking, and effectiveness monitoring. Cross-Functional Support, Documentation, and Reporting Serves as a coordination point between Payer Audit, Accreditation, Quality, Operations, and Compliance stakeholders. Prepares summaries, reports, and presentation materials for functional leadership and governance committees. Maintains accurate, traceable, and audit-ready documentation in accordance with internal standards and regulatory requirements. Supports development and delivery of staff-facing education and job aids related to audit readiness and accreditation standards. Minimum Requirement Degree or equivalent and typically requires 4+ years of relevant experience. Education 4-year undergraduate college degree preferred; an equivalent combination of education and directly relevant experience will be considered. Certified Pharmacy Technician (CPhT) preferred. Critical Skills 4+ years of combined experience in specialty pharmacy, pharmacy operations, PBM, or pharmacy regulatory and payer compliance. AND 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. Specialized Knowledge & Skills Specialty pharmacy experience strongly preferred. Working knowledge of state pharmacy audit statut