Pharmacy Claims Auditor

Job Summary

Identifying and evaluating potential waste and compliance issues, the full-time remote Pharmacy Claims Auditor will conduct in-depth analyses of pharmacy claims, educate network pharmacies on compliance standards, and support audit-related projects.

Key responsibilities

• Conduct in-depth analysis of large datasets and audit findings to detect high-risk pharmacy claims and billing irregularities
• Research and select appropriate audit samples, prioritizing pharmacy claims based on risk indicators and compliance concerns
• Evaluate pharmacy claims and supporting documentation to ensure alignment with contractual terms and applicable regulations

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 work experience in pharmacy settings 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 the need for work visa or residency sponsorship