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 reversalsRequirements:• 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 sponsorshipBenefits:• Health insurance• 401(k) matching• Paid time off• Professional development opportunities Apply tot his job