Pharmacy Audit Specialist - Compliance & Recoveries

Capital Rx

Denver (CO)

Hybrid

USD 53,000 - 80,000

Full time

14 days+

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Job summary

Judi Health is seeking a Pharmacy Auditor to conduct comprehensive audits of network pharmacies, ensuring contractual, regulatory, and client compliance while identifying billing discrepancies and recoveries.

The role collaborates with Compliance, Legal, Finance, Provider Relations, Clinical, and FWA teams, performing remote, desk, and on-site audits, with travel as needed in hybrid Denver/ NYC/ Charlotte regions.

Qualifications

Bachelor's degree in Healthcare Administration, Pharmacy, Accounting, Finance or related field preferred.
Two to five years of experience in pharmacy auditing or related field required.
CPhT designation strongly preferred; additional certifications are a plus.

Responsibilities

Conduct desk, remote and on-site pharmacy audits for compliance with contracts, regulations, and operations.
Review records (prescriptions, invoices, inventory, dispensing logs) for accuracy.
Analyze claims and utilization data to spot discrepancies and overpayments.
Document findings and financial recoveries per laws and client needs.
Prepare audit reports with root causes, impact and corrective actions.
Present observations to pharmacies and internal stakeholders professionally.
Monitor corrective actions and coordinate with Special Investigations unit when needed.
Support regulatory examinations, client audits, and special projects.
Maintain thorough audit documentation and stay current on regulations.