Overview:
Headquarterd in Morrisville, NC Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain.
Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace and provides commercialization solutions to accelerate value and enhance patient lives.
Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment.
We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that eliminate barriers for patients, increase access to medications, and help patients receive life-saving treatments.
Our Trades Team has several main functions.
We manage copay and voucher pharmacy programs for our clients as well as medical benefit programs.
We also have a Fraud, Waste, and Abuse (FWA) team that identifies potential instances of irregularities within the pharmacy network, performs detailed investigations, and implements measures to mitigate or eliminate the concerns.
You will complement our FWS detection team with a focus on program abuse and fraud detection.
The FWA team protects the integrity of our copay and voucher assistance programs in the marketplace across all of Mercalis.
As the workload dictates, the candidate would also assist in other areas of the team and in the process develop an understanding of how we create and manage our clients' programs.
This individual will assist the Analysts and Investigators with monitoring/detection, investigation, and reporting of FWA in an effort to reduce and proactively protect our clients’ programs from being used inappropriately.
Specifically, the candidate will assist by contacting pharmacies and providers to validate prescriptions, pharmacy licenses, pharmacy reviews, sanctions, websites, etc.
at the direction of the FWA Team.
The role may also include reviewing data with the Analysts and ensuring we accurately record all aspects of the investigation and enter the information in the appropriate database.
The candidate must be very detail-oriented and have superior communication skills.
Responsibilities:
At the direction of the FWA Team, the candidate would:
Reach out to providers and pharmacies to validate information
Ensure impeccable record keeping standards are maintained
Research pharmacy licenses, websites, sanctions, locations, etc.
Contact pharmacies and/or healthcare providers to gather information and assess if abusive actions are likely being done intentionally or unknowingly
Assist in analyzing data and trends from claims where Mercalis benefit programs have been used and that exhibit suspicious behavior
At the direction of the Director, assist in other areas of Trades, such as the pharmacy operations team, and at their direction, work with our internal partners to gather information about the pharmacy programs we manage for our clients.
Other responsibilities deemed appropriate as determined by the Director
Qualifications:
Your career goals should include some aspects of data management
Excellent communications skills
Knowledge of Microsoft 365 programs (Word, Excel)
SQL knowledge a plus
Comfort level learning and working in multiple internal proprietary systems and databases
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