Pharmacy Claims Auditor - Remote

Talentify.io; United States; Remote; USD 50,000 - 60,000; Full time

Job summary

A healthcare organization is seeking a Claims Auditor to ensure accurate pharmacy claims processing. Responsibilities include validating claim documentation, analyzing claims for errors, and educating pharmacies on billing requirements. Candidates should have a Bachelor's degree in Health Science, Pharmacy Technician Certification, and 2 years of relevant experience. This position offers flexible remote work and opportunities for career growth.

Benefits

Flexible work environment

Career advancement opportunities

Collaborative workplace culture

Qualifications

• 2 years of experience in various pharmacy settings.
• Ability to validate claims and support documentation.
• Proficient with healthcare regulations.

Responsibilities

• Validate claim documentation and systems data.
• Communicate with pharmacies for documentation.
• Analyze pharmacy claims for errors.

Skills

Communication skills

Analytical skills

Attention to detail

Education

Bachelor’s degree in Health Science or related field

National Pharmacy Technician Certification

Tools

MS Word

Excel

Database software

Job description

13 hours ago Be among the first 25 applicants

Employer Industry: Pharmacy Benefit Management

Why Consider This Job Opportunity

• Potential pay up to $40.87 per hour based on experience and skills
• Opportunity for career advancement and growth within the organization
• Flexible remote work environment
• Supportive and collaborative workplace culture
• Chance to make a significant impact on pharmacy claims accuracy and compliance
  
  

What To Expect (Job Responsibilities)

• Validate claim documentation and systems data to ensure accurate processing in accordance with contractual and regulatory obligations
• Solicit documentation from pharmacies to support claim submissions through various communication methods
• Proactively communicate and follow up with pharmacies to ensure timely receipt and review of documentation
• Analyze pharmacy claims to identify high-risk errors and select claims or pharmacies for audit
• Educate pharmacies on billing requirements and practices in alignment with pharmacy provider guidelines
  
  

What Is Required (Qualifications)

• Bachelor’s degree in Health Science or related field, or equivalent combination of education and experience; High School diploma or GED required
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• Minimum of 2 years of experience in retail, long-term care, specialty, home infusion, or mail order pharmacy, including 1 year in an operations, audit, or quality assurance environment
• Must be eligible to work in the United States without the need for work visa or residency sponsorship
• Proficiency in MS Word, Excel, and database software
  
  

How To Stand Out (Preferred Qualifications)

• 3 years of previous audit experience
• Current Registration with State Board of Pharmacy in the state where the position is located
• Previous experience in Pharmacy Benefit Management (PBM)
  
  

#PharmacyBenefitManagement #RemoteWork #CareerGrowth #AuditExperience #PharmacyClaims

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Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative

• Industries

  Staffing and Recruiting

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