Working remotely in a full-time capacity, the Pharmacy Claims Auditor will identify and evaluate potential waste and compliance issues through the pharmacy audit process, educate network pharmacies, and drive contract compliance while analyzing large datasets and audit findings. Key responsibilities Conduct in-depth analysis of large datasets and audit findings to detect high-risk pharmacy claims and identify billing irregularities Research and select appropriate audit samples while prioritizing pharmacy claims based on risk indicators Evaluate pharmacy claims and supporting documentation for alignment with contractual terms and regulations Required qualifications Bachelor's degree in Health Science or related area of study, or equivalent combination of education and work experience; High school diploma or GED required 2 years of work experience in pharmacy settings, 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 the need for work visa or residency sponsorship
Pharmacy Claims Auditor in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.