Pharmacy Claims Audit Specialist

MedImpact Healthcare Systems Inc.; San Diego (CA); On-site; USD 34,000 - 56,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off / Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. in San Diego, CA is seeking a Compliance Auditor to conduct desk and onsite audits of network pharmacies, verify credentials, and ensure regulatory compliance across federal, state, and contract requirements.

You will review claims data, document findings, communicate results to pharmacies, and support client invoicing with accurate, timely reporting.

Qualifications

• BS/BA and 2+ years’ experience or equivalent combination of education and experience.
• Intermediate to advanced MS Office (Word, Excel, PowerPoint, Project, Outlook).
• Familiarity with relational databases and SQL front ends is desirable.

Responsibilities

• Prepares and completes Pre-Pay reviews, desk and onsite audits to evaluate compliance.
• Analyze pharmacy profile reports for discrepancies, fraud, and drug abuse.
• Prepare prescription requests for audits as appropriate.
• Execute in-depth claims data examinations to identify patterns and outcomes.
• Develops audit outcome reports and correspondence for pharmacies.

Skills

Audit analysis

Regulatory knowledge

Communication

Data interpretation

Education

BS/BA and 2+ years’ experience

Tools

MS Office

SQL

MedAccess & MedOptimize

Job description

MedImpact Healthcare Systems, Inc. in San Diego, CA is seeking a Compliance Auditor to conduct desk and onsite audits of network pharmacies, verify credentials, and ensure regulatory compliance across federal, state, and contract requirements.

You will review claims data, document findings, communicate results to pharmacies, and support client invoicing with accurate, timely reporting.