Pharmacy Claims Auditor
Job Description: • Conduct in-depth analysis of large datasets and audit findings to detect high-risk pharmacy claims, identify billing irregularities, and uncover patterns of non-compliance or systemic errors • Research and select appropriate audit samples strategically, prioritize pharmacy claims and providers for review based on risk indicators and compliance concerns • Evaluate pharmacy claims and supporting documentation to determine whether claims align with contractual terms, provider manual policies, and applicable state/federal regulations • Educate pharmacies on documentation standards and compliance best practices, while supporting accurate data and financial reimbursement to ensure appropriate claim corrections or reversals Requirements: • Bachelor’s degree in Health Science or related area of study, or equivalent combination of education and related work experience • High school diploma or GED required • 2 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and Pharmacy Benefit Management experience to include 1 year of work experience in an operations, audit or quality assurance environment • National Pharmacy Technician Certification through PTCB, ExCPT (CPhT) • Must be eligible to work in the United States without the need for work visa or residency sponsorship Benefits: • Health insurance • 401(k) matching • Paid time off • Professional development opportunities Apply tot his job Apply tot his job