Remote Senior Pharmacy Claims Audit Lead

Prime Therapeutics LLC; Albuquerque (NM); Remote; USD 59,000 - 94,000; Full time

Job summary

Prime Therapeutics LLC is seeking an experienced Senior Pharmacy Claims Auditor to work in a remote capacity in the United States. The role focuses on education, training, and guiding the audit process to identify waste, non-compliant practices, and improper reimbursements.

You will lead tool development, analytics, and process enhancements to deliver business value. Responsibilities include training delivery, cross-functional collaboration, trend analysis, and SME representation for system

Qualifications

• Bachelor's degree in Health Science or related area of study, or equivalent combination of education and related work experience; HS diploma or GED is required
• 5 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and Pharmacy Benefit Management experience to include 3 years of work experience in audit or quality assurance
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• Must be eligible to work in the United States without the need for work visa or residency sponsorship

Responsibilities

• Collaborate with cross-functional teams to identify, develop, deliver, and support training focused on trend analysis, audit planning, procedures, and system process, along with identifying technology enhancement opportunities
• Provide guidance and operational support to the Pharmacy Audit Operations team, promoting best practices, leading projects, and resolving issues
• Analyze claim and audit data to support ongoing audit analytic efforts, identify trends and refinements; collaborate with other department staff to create enhanced reporting and represent audit team as the SME for system enhancement initiatives and testing
• Other duties as assigned

Skills

Audit

Training

Data Analysis

MS Word

Excel

Database software

Education

Bachelor's degree in Health Science or related area of study

Tools

MS Word

Excel

Database software

Job description

Prime Therapeutics LLC is seeking an experienced Senior Pharmacy Claims Auditor to work in a remote capacity in the United States. The role focuses on education, training, and guiding the audit process to identify waste, non-compliant practices, and improper reimbursements.

You will lead tool development, analytics, and process enhancements to deliver business value. Responsibilities include training delivery, cross-functional collaboration, trend analysis, and SME representation for system