Pharmacy Audit & Compliance Analyst

Capital Rx; New York (NY); Hybrid; USD 53,000 - 80,000; Full time

Job summary

Judi Health in New York, NY is seeking a Pharmacy Auditor to conduct comprehensive audits of network pharmacies, ensuring compliance with contracts and regulations and safeguarding resources.

You will review pharmacy records, analyze claims data, calculate recoveries, and prepare detailed audit reports. The role requires collaboration with Compliance, Legal, Finance, and other teams, with hybrid travel to NYC, Denver, or Charlotte as needed.

Qualifications

• Bachelor's degree in Healthcare Administration, Pharmacy, or related field preferred.
• CPhT designation strongly preferred.
• Auditing/compliance certifications related to healthcare are a plus.

Responsibilities

• Conduct desk, remote, and on-site pharmacy audits to evaluate compliance with contractual, regulatory, and operational requirements.
• Review prescription records, claims data, purchase invoices, inventory documentation, dispensing logs, and other supporting records to validate billed claims.
• Analyze pharmacy claims and utilization data to identify discrepancies, overpayments, and non-compliance areas.
• Calculate and document audit findings and financial recoveries per audit methodologies and laws.
• Prepare clear audit reports detailing findings, root causes, financial impact, and recommended actions.
• Communicate audit observations and recovery determinations to pharmacies and stakeholders.
• Monitor corrective action plans and follow-up activities for resolution of deficiencies.
• Collaborate with Special Investigations Unit for potential fraud, waste, or abuse concerns.

Skills

Analytical

Attention to detail

Communication

Independent

Cross-functional collaboration

MS Excel

Data analysis

Problem-solving

Education

Bachelor's degree in Healthcare Administration

Certified Pharmacy Technician (CPhT)

Auditing/compliance certifications (plus)

Job description

Judi Health in New York, NY is seeking a Pharmacy Auditor to conduct comprehensive audits of network pharmacies, ensuring compliance with contracts and regulations and safeguarding resources.

You will review pharmacy records, analyze claims data, calculate recoveries, and prepare detailed audit reports. The role requires collaboration with Compliance, Legal, Finance, and other teams, with hybrid travel to NYC, Denver, or Charlotte as needed.