Pharmacy Network Auditor

Job Summary

To support the growth of the Pharmacy Network Audit program, the full-time Pharmacy Network Auditor will manage internal pharmacy audits, collaborate with external vendors to address Fraud Waste Abuse (FWA), and ensure compliance with client contract requirements, working remotely or onsite in Boston.

Key responsibilities

• Evaluate, report, and monitor all aspects of Pharmacy Network Auditing services
• Draft and communicate audit findings to internal stakeholders and provide Quarterly Network Audit Performance Reports to leadership
• Leverage BI Tools to analyze claims data for potential investigational FWA breaches and maintain audit documentation

Required qualifications

• Previous Pharmacy Audit Experience with a strong understanding of industry guidelines
• 5+ years of experience in a Retail Pharmacy setting and/or Pharmacy Benefits Management organization
• Proficient knowledge of URAC and CMS network requirements along with Federal and State level auditing standards
• Ability to research, analyze, and report on audit results and industry trends in FWA
• Proficiency in MS Word and Excel