Pharmacy Claims Auditor, CPhT

Jobtailor; Kentucky; On-site; USD 60,000 - 85,000; Full time

Job summary

Jobtailor is seeking a Pharmacy Auditor to evaluate pharmacy records against claims data and ensure compliance with federal and state regulations. The role requires proactive research of applicable laws, clear communication with pharmacies, and thorough documentation of audit findings.

Responsibilities include coordinating onsite and remote audits, scheduling confirmations, and reporting results to clients.

Qualifications

• National CPhT Certification required or obtainable within initial months.
• Extensive retail pharmacy experience.
• Willingness to travel up to 25% (overnight trips).
• Valid driver's license and reliable car.

Responsibilities

• Examine and interpret pharmacy records against submitted claim data for discrepancies.
• Apply client instructions and regulations when accessing pharmacy documentation.
• Research pharmacy regulations and state/federal laws related to prescriptions.
• Respond to audit results inquiries from clients.
• Report audit results to clients on a periodic basis.
• Conduct onsite, desktop, and credentialing audits professionally.
• Review documentation against claim data using prescription knowledge.
• Produce detailed descriptions of pharmacy operations and procedures.
• Make confirmation calls to pharmacies prior to audit dates.
• Handle audit reschedules and related tasks.
• Perform other assigned duties.

Skills

National CPhT Certification

Retail Pharmacy Experience

Pharmacy Auditing

Regulatory Compliance

Microsoft Office Proficiency

Tools

Windows

Microsoft Office

Job description

• Examine and interpret pharmacy records against submitted claim data for discrepancies
• Apply client instructions, federal and state regulations, and standards of practice when accessing pharmacy documentation
• Research board of pharmacy regulations and state/federal laws related to prescription requirements and pharmacy practices
• Respond to pharmacy calls about audit results
• Report audit results to clients periodically
• Conduct onsite, desktop, and credentialing audits professionally and respectfully
• Review pharmacy-submitted documentation against claim data using prescription knowledge
• Assess and produce detailed descriptions of pharmacy operations and procedures
• Make confirmation calls to pharmacies before audit dates
• Handle audit reschedules
• Perform other assigned duties

Requirements

• National CPhT Certification through the Pharmacy Technician Certification Board (PTCB), or ability to obtain it within the first few months
• Extensive retail pharmacy experience
• Living within commutable distance of the assigned territory: New Orleans, LA; Charlotte, NC; Louisville, KY; St. Louis, MO; Indianapolis, IN; or Cincinnati, OH
• Valid driver's license and reliable car for visiting pharmacies
• Ability to travel overnight/by flight one week per month (25%)
• Proficiency with Windows and Microsoft Office
• Ability to stand for long periods, up to 8 hours
• Ability to lift approximately 20-pound boxes containing prescription records

Core Competencies

Demonstrates expertise in pharmacy operations and compliance with federal and state regulations, alongside strong auditing skills and the ability to communicate effectively with pharmacy personnel. Proficient in analyzing pharmacy records and claim data to ensure accuracy and adherence to standards.

Highest-signal resume keywords

• National CPhT Certification
• Retail Pharmacy Experience
• Pharmacy Auditing
• Regulatory Compliance
• Microsoft Office Proficiency

Hard Skills

• Pharmacy Record Examination
• Claim Data Analysis
• Audit Reporting
• Prescription Knowledge
• Detailed Documentation Assessment

Soft Skills

• Professional Communication
• Respectful Interaction
• Problem-Solving

Certifications & Qualifications

• National CPhT Certification

Industry Keywords

• Pharmacy Regulations
• State/Federal Laws
• Audit Procedures
• Credentialing Audits
• Pharmacy Operations

Tools & Technologies

• Windows
• Microsoft Office