Pharmacy Claims Auditor

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