Pharmacy Claims Auditor I — Compliance & Data Insight

MedImpact Healthcare Systems, Inc.; San Diego (CA); On-site; USD 53,000 - 86,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off / Holidays

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. seeks a pharmacist auditor to conduct compliance desk or onsite audits of network pharmacies, verify credentials, and adjust claims based on audit findings. You will ensure timely completion and maintain documentation for clients.

The role requires strong knowledge of pharmacy regulations, attention to detail, and the ability to work independently with minimal direction; travel to client sites is possible.

Qualifications

• BS/BA and 2+ years’ experience or equivalent combination of education and experience.
• Pharmacy Technician license or national certification (PTCB) required.
• Knowledge of federal and state pharmacy regulations and audit practices.

Responsibilities

• Prepares and completes Pre-Pay reviews, desk and onsite audits to evaluate compliance with contractual, regulatory, and pharmacy practice requirements.
• Analyzes pharmacy profile reports for possible claim discrepancies, fraud, and drug abuse.
• Develops audit outcome reports and supporting correspondence for pharmacies, clearly documenting findings, recoveries, and corrective actions.

Skills

MS Office

SQL

MedAccess

MedOptimize

Pharmacy knowledge

Education

BS/BA

Tools

MS Office

SQL

MedAccess

MedOptimize

Job description

MedImpact Healthcare Systems, Inc. seeks a pharmacist auditor to conduct compliance desk or onsite audits of network pharmacies, verify credentials, and adjust claims based on audit findings. You will ensure timely completion and maintain documentation for clients.

The role requires strong knowledge of pharmacy regulations, attention to detail, and the ability to work independently with minimal direction; travel to client sites is possible.