Pharmacy Audit & Network Analyst

Jobtailor; Arizona; Hybrid; USD 52,000 - 75,000; Full time

Job summary

Jobtailor is seeking a Pharmacy Audit Support professional in the United States. You will conduct outbound calls to network pharmacies to verify claim information, distribute audit requests, and review prescriptions for CMS and contract compliance.

You will analyze incoming documentation and enter data, while responding to inquiries about Medicare audit programs. The role requires familiarity with pharmacy claims processing systems, strong Excel/Access/SQL skills, and a solid high school level

Qualifications

• 1+ years of experience in a pharmacy or PBM environment (5+ years preferred).
• 2+ years of experience with pharmacy claims processing systems.
• Working knowledge of CMS Medicare Part D compliance regulations.

Responsibilities

• Conduct outbound calls to network pharmacies to verify claim information.
• Distribute audit requests and documentation requirements to pharmacies.
• Review prescriptions and supporting documents to ensure CMS and CVS Health contractual compliance.
• Analyze incoming pharmacy documents and accurately enter data into internal audit systems.
• Respond to pharmacy inquiries related to Medicare audit programs.
• Track and report progress on assigned audit activities.
• Collaborate with internal stakeholders to align on audit objectives and business priorities.

Skills

communication

collaboration

organizational skills

problem-solving

Education

PTCB certification

High School Diploma

GED

Tools

Microsoft Excel

Microsoft Access

SQL

Job description

Jobtailor is seeking a Pharmacy Audit Support professional in the United States. You will conduct outbound calls to network pharmacies to verify claim information, distribute audit requests, and review prescriptions for CMS and contract compliance.

You will analyze incoming documentation and enter data, while responding to inquiries about Medicare audit programs. The role requires familiarity with pharmacy claims processing systems, strong Excel/Access/SQL skills, and a solid high school level