Pharmacy Auditor I

EXL; Oregon; Hybrid; USD 45,000 - 58,000; Full time

Job summary

EXL Health, located 100% remote in the US, seeks a Pharmacy Auditor I to perform desk and onsite audits of prescription claims. The role requires a CPhT and active license, with travel up to 10% for team meetings and limited client engagements. Salary ranges from $45,000 to $58,000 annually depending on experience.

The position emphasizes accuracy, HIPAA compliance, and timely documentation across audit workflows and client requirements.

Qualifications

• High School Diploma or Equivalent.
• Certified Pharmacy Technician (CPhT) and active state license/registration where required.

Responsibilities

• Conduct desk audits by reviewing prescription claims and supporting docs for compliance and discrepancies.
• Review pharmacy records including prescriptions, signature logs, proof of delivery, invoices and dispensing records.
• Apply audit procedures and criteria to determine claim support and identify recoverable findings.
• Maintain complete audit documentation and case notes in required systems and workflows.
• Perform quality review and validation to ensure findings are accurate and complete.
• Conduct onsite or virtual audits, interacting with pharmacy personnel and gathering evidence.
• Travel up to 10% annually as needed for meetings or client engagements.
• Communicate status, issues, and deadlines with Audit Coordinators and stakeholders.
• Stay updated on state/federal requirements and HIPAA/privacy guidelines.

Education

High School Diploma or Equivalent

Job description

EXL Health is hiring a Pharmacy Auditor I. This is a full-time, work from home opportunity.

Salary Range: $45,000-$58,000 (based on experience, skills, and qualifications)

Location: 100% Remote (US Based). Up to 10% annual travel (for team meetings and limited client onsite engagements)

Responsibilities

• Conduct assigned pharmacy desk audits by reviewing prescription claims and supporting documentation to determine compliance with contractual, regulatory, and program requirements and identify potential discrepancies or overpayments.
• Review pharmacy records and supporting documentation, including prescription records, signature logs, proof of delivery, invoices, dispensing records, and other applicable documentation, and accurately document audit findings.
• Apply established audit procedures, client requirements, discrepancy codes, and validation criteria to determine whether pharmacy claims are supported and identify potential recoverable findings.
• Maintain complete, accurate, and timely audit documentation, case notes, evidence, findings, and status updates within required systems and workflows.
• Perform quality review and validation activities for assigned pharmacy audits to ensure findings and supporting documentation are accurate, complete, and consistent with audit requirements.
• Conduct onsite or virtual pharmacy audits as assigned, including interaction with pharmacy personnel, records review, evidence collection, and documentation of findings.
• Onsite activity and travel may occur based on business or client needs; travel is not a fixed percentage requirement for this position.
• Communicate with Audit Coordinators, management, and internal stakeholders regarding audit status, documentation issues, findings, deadlines, and matters requiring escalation.
• Maintain knowledge of applicable pharmacy audit requirements, client policies, pharmacy practices, and relevant state and federal requirements.
• Maintain compliance with HIPAA, confidentiality, privacy, and information-security requirements when handling pharmacy and patient information.
• Meet established productivity, quality, accuracy, and timeliness expectations and perform other pharmacy audit-related duties as assigned.

Qualifications

• High School Diploma or Equivalent
• Certified Pharmacy Technician (CPhT) and active state pharmacy technician license/registration where required
• The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.