Pharmacy Audit & Compliance Specialist

Triwill Group; New York, Northern (NY, KY); Hybrid; USD 53,000 - 80,000; Full time

Benefits offered by this job

Hybrid work environment

Travel opportunities

Job summary

Judi Health is seeking a Pharmacy Auditor to conduct audits of network pharmacies, ensuring contractual obligations, regulatory requirements, and accurate claims processing. You will identify billing discrepancies and promote program integrity.

You will collaborate with Compliance, Legal, Finance, Provider Relations, Clinical, and FWA teams to support corrective actions, recoveries, and education initiatives; travel for on-site audits is possible.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Pharmacy, Accounting, Finance, or related field preferred.
• CPhT designation strongly preferred.
• Certifications related to auditing, compliance, healthcare fraud investigation, or pharmacy operations are a plus.

Responsibilities

• Conduct desk, remote, and on-site pharmacy audits to evaluate contractual and regulatory compliance.
• Review prescription records, claims data, invoices, inventory logs to validate billing accuracy.
• Analyze claims data to identify discrepancies, overpayments, and non-compliance areas.
• Document audit findings and recoveries in line with approved methodologies and laws.
• Prepare clear audit reports with findings, root causes, and corrective actions.
• Communicate observations to pharmacies and internal stakeholders professionally.
• Monitor action plans and follow-up to ensure deficiencies are resolved.
• Collaborate with Special Investigations Unit when fraud, waste or abuse concerns arise.
• Support regulatory examinations, client audits, and compliance education initiatives.
• Maintain thorough documentation per audit standards and retention policies.
• Stay updated on federal/state pharmacy regulations, CMS, NCPDP, and PBM policies.

Skills

Analytical thinking

Attention to detail

Communication skills

Time management

Excel

Data analysis tools

Independent work

Education

Bachelor's degree in Healthcare Administration, Business Administration, Pharmacy, Accounting, Finance, or related field

CPhT certification

Tools

Audit software

Data analytics tools

Job description

Judi Health is seeking a Pharmacy Auditor to conduct audits of network pharmacies, ensuring contractual obligations, regulatory requirements, and accurate claims processing. You will identify billing discrepancies and promote program integrity.

You will collaborate with Compliance, Legal, Finance, Provider Relations, Clinical, and FWA teams to support corrective actions, recoveries, and education initiatives; travel for on-site audits is possible.