Pharmacy Payment Integrity Lead

Location: Remote

Compensation: Salary

Reviewed: Tue, Dec 30, 2025

This job expires in: 30 days

Job Category: Management

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Bachelors

Job Summary

A company is looking for a Pharmacy Payment Integrity Program Development Lead.

Key Responsibilities

Lead the design and execution of a multi-year strategic roadmap for the Pharmacy FWA program
Analyze integrated medical and pharmacy data to detect patterns of abnormal utilization and emerging fraud schemes
Prepare and present regular reports on program ROI, regulatory risk exposure, and strategic direction to Executive Leadership

Required Qualifications

Bachelor's degree and a minimum of 6+ years of experience in Pharmacy Benefit Management or related fields
Expert-level knowledge of Medicare Part B/D claims processing and CMS FWA requirements
Ability to multitask and drive outcomes across cross-functional teams
Experience with regulatory compliance and pharmacy claims processing
Expert proficiency in querying large datasets using SQL

COMPLETE JOB DESCRIPTION

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