Certified Pharmacy Technician Auditor

Job Summary

To ensure accurate provider payments and detect fraud, waste, or abuse, the fully remote Certified Pharmacy Technician Auditor will conduct pharmacy claim audits, analyze billing patterns, and improve audit processes while maintaining comprehensive documentation.

Key responsibilities

• Conduct audits of pharmacy claims to ensure accuracy of provider payments and charges
• Analyze provider billing patterns to identify potential fraud, waste, or abuse
• Initiate and validate claim adjustments, maintaining comprehensive audit documentation and preparing statistical reports

Required qualifications

• Certified Pharmacy Technician (CPhT) required
• Minimum of four years of relevant experience, including at least two years in retail or hospital pharmacy and two years in pharmacy audit
• Extensive understanding of healthcare provider audit practices and medical terminology
• Familiarity with fraud, waste, and abuse detection methodologies
• Proficiency in Microsoft Office applications, particularly advanced Excel skills