PBM Audit & Specialty Pharmacy Specialist

ZealHire Inc.; Northern (KY); Hybrid; USD 60,000 - 90,000; Full time

Job summary

PBM Audit & Specialty Pharmacy is seeking a Temporary Audit & Appeals Specialist to manage PBM, payer, and payment integrity audits. The role handles high-volume requests, ensures regulatory compliance, and supports audit appeals and recoupment risk minimization.

Ideal candidates have 3+ years in specialty pharmacy or PBM audits, strong Excel/Outlook skills, and excellent written communication. This position requires Cleveland or EST timezone alignment and a Monday–Friday schedule.

Qualifications

• 3+ years in specialty pharmacy or PBM audits.
• Experience reviewing pharmacy claims and payer requirements.
• Strong written communication and documentation skills.
• Advanced Microsoft Excel, Word, and Outlook proficiency.

Responsibilities

• Coordinate and administer PBM audits and payer reviews.
• Process, track, and respond to audit requests to minimize recoupment risk.
• Prepare audit appeals and track outcomes.
• Maintain regulatory and payer compliance.
• Manage high-volume audit workload (>1,700 requests annually).

Skills

PBM audits

Revenue integrity

Payer operations

Excel/Word/Outlook

Documentation

Multitasking

Analytical thinking

Tools

Excel

Word

Outlook

Job description

PBM Audit & Specialty Pharmacy is seeking a Temporary Audit & Appeals Specialist to manage PBM, payer, and payment integrity audits. The role handles high-volume requests, ensures regulatory compliance, and supports audit appeals and recoupment risk minimization.

Ideal candidates have 3+ years in specialty pharmacy or PBM audits, strong Excel/Outlook skills, and excellent written communication. This position requires Cleveland or EST timezone alignment and a Monday–Friday schedule.