Pharmacy Auditor: Claims Integrity & Compliance

Transformcap

Colorado

Hybrid

USD 53,000 - 80,000

Full time

14 days+

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Benefits offered by this job

Hybrid work environment

Job summary

Judi Health is seeking a Pharmacy Auditor to lead comprehensive audits of network pharmacies, ensuring regulatory and contractual compliance while identifying overpayments and recovery opportunities. The role collaborates with Compliance, Legal, Finance, and FWA teams to support corrective actions and program integrity.

The position requires 2–5 years in pharmacy auditing or related fields, with a hybrid work arrangement across NYC, Denver, or Charlotte areas.

Qualifications

Bachelor's degree in a related field is preferred.
CPhT designation strongly preferred.
Auditing, compliance, fraud investigation certifications are a plus.

Responsibilities

Conduct desk, remote, and on-site pharmacy audits to evaluate contractual, regulatory, and operational requirements.
Review prescription records, claims data, invoices, and inventory documentation to validate accuracy of billed claims.
Analyze claims data to identify discrepancies, overpayments, and non-compliance.
Document audit findings and financial recoveries per audit methodologies and laws.
Prepare clear audit reports with findings, impact, and corrective actions.
Communicate observations to pharmacies and internal stakeholders professionally.
Monitor corrective action plans to ensure deficiencies are resolved.
Collaborate with Special Investigations Unit on potential fraud, waste, and abuse.
Support regulatory examinations, client audits, and special projects as needed.
Maintain thorough documentation per audit standards and retention policies.