Pharmacy Claims Auditor

Job Summary

A company is looking for a Pharmacy Claims Auditor - Remote.

Key Responsibilities

• Conduct in-depth analysis of large datasets and audit findings to identify high-risk pharmacy claims and billing irregularities
• Research and select appropriate audit samples, prioritizing claims based on risk indicators
• Evaluate pharmacy claims against contractual terms and educate pharmacies on compliance best practices

Required Qualifications

• Bachelor's degree in Health Science or related area, or equivalent combination of education and experience; High school diploma or GED required
• 2 years of experience in pharmacy or Pharmacy Benefit Management, including 1 year in operations, audit, or quality assurance
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• Must be eligible to work in the United States without sponsorship