Remote Pharmacy Auditor I - Claims Compliance & Recovery

ExlService Holdings, Inc.; United States; Remote; USD 45,000 - 58,000; Full time

Job summary

EXL Health is seeking a Pharmacy Auditor I for a full-time, 100% remote position based in the United States. You will conduct desk audits of pharmacy claims, review supporting documentation, and document findings to ensure compliance with contracts, regulatory requirements, and program guidelines.

Requirements include a High School Diploma (or equivalent) and a Certified Pharmacy Technician (CPhT) with an active license where required.

Qualifications

• High School Diploma or Equivalent
• Certified Pharmacy Technician (CPhT) and active state pharmacy technician license/registration where required

Responsibilities

• Conduct assigned pharmacy desk audits by reviewing prescription claims and supporting documentation to determine compliance with contractual, regulatory, and program requirements and identify potential discrepancies or overpayments.
• Review pharmacy records and supporting documentation, including prescription records, signature logs, proof of delivery, invoices, dispensing records, and other applicable documentation, and accurately document audit findings.
• Apply established audit procedures, client requirements, discrepancy codes, and validation criteria to determine whether pharmacy claims are supported and identify potential recoverable findings.
• Maintain complete, accurate, and timely audit documentation, case notes, evidence, findings, and status updates within required systems and workflows.
• Perform quality review and validation activities for assigned pharmacy audits to ensure findings and supporting documentation are accurate, complete, and consistent with audit requirements.
• Conduct onsite or virtual pharmacy audits as assigned, including interaction with pharmacy personnel, records review, evidence collection, and documentation of findings. Onsite activity and travel may occur based on business or client needs; travel is not a fixed percentage requirement for this position.
• Communicate with Audit Coordinators, management, and internal stakeholders regarding audit status, documentation issues, findings, deadlines, and matters requiring escalation.
• Maintain knowledge of applicable pharmacy audit requirements, client policies, pharmacy practices, and relevant state and federal requirements.
• Maintain compliance with HIPAA, confidentiality, privacy, and information-security requirements when handling pharmacy and patient information.
• Meet established productivity, quality, accuracy, and timeliness expectations and perform other pharmacy audit-related duties as assigned.

Education

High School Diploma or Equivalent

Certified Pharmacy Technician (CPhT)

Job description

EXL Health is seeking a Pharmacy Auditor I for a full-time, 100% remote position based in the United States. You will conduct desk audits of pharmacy claims, review supporting documentation, and document findings to ensure compliance with contracts, regulatory requirements, and program guidelines.

Requirements include a High School Diploma (or equivalent) and a Certified Pharmacy Technician (CPhT) with an active license where required.