Pharmacy Claims Auditor CPhT: Compliance & Audit Specialist

Jobtailor

Kentucky

On-site

USD 60,000 - 85,000

Full time

5 days ago

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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.