Pharmacy Compliance & Audit Specialist

MCS Puerto Rico

San Juan (PR)

On-site

USD 70,000 - 95,000

Full time

2 days ago

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Job summary

MCS Puerto Rico in San Juan, PR, seeks an experienced Compliance Auditor to oversee pharmacy audit, monitoring, and CMS compliance across all lines of business. You will evaluate PBM performance, assess risks, and drive corrective actions to ensure adherence to CMS regulations and contractual requirements.

The role requires a Bachelor’s or Associate’s degree in a related field and 2+ years in pharmacy operations, audit, or compliance.

Qualifications

Bachelor's or associate degree with pharmacy operations and compliance exposure.
Experience in monitoring PBM performance, CMS regulations, and formulary management.
Proven ability to analyze audit findings and prepare CAPs.

Responsibilities

Identify compliance issues, risks, and process deficiencies and recommend corrective actions.
Develop and monitor Corrective Action Plans with documentation and tracking.
Analyze claims and audit results to detect trends and opportunities for improvement.
Perform audits related to CMS and PBM operations, including formulary management and notifications.
Collaborate with internal teams and vendors to resolve findings and support regulatory readiness.
Prepare dashboards, audit reports, and compliance summaries for leadership.