Remote Senior Pharmacy Claims Audit Leader

Prime Therapeutics; Cheyenne (WY); Remote; USD 59,000 - 94,000; Full time

Job summary

Prime Therapeutics is seeking a Senior Pharmacy Claims Auditor to remotely lead audit initiatives and develop tools, analytics, and training to identify waste and ensure compliance in pharmacy reimbursements.

The role requires a Bachelor’s in Health Science or related field, 5 years in pharmacy with audit/QA, and a PTCB/ExCPT certification. Strong data analysis, cross-functional collaboration, and SME capability are essential.

Qualifications

• Must have a Bachelor's degree in Health Science or related field or equivalent.
• 5 years of work experience in retail, long term care, specialty, home infusion, mail order pharmacy or combined pharmacy with audit/quality assurance experience.
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT).
• Eligible to work in the United States without visa sponsorship.

Responsibilities

• Collaborate with cross-functional teams to develop and support training on trend analysis, audit planning, and procedures.
• Provide guidance to the Pharmacy Audit Operations team and lead projects.
• Analyze claim and audit data to identify trends and improve reporting; act as SME for system enhancements.
• Perform other duties as assigned.

Skills

Agility

Critical thinking

Communication

Cross-functional collaboration

De-escalation

Risk judgement

Education

Bachelor's degree in Health Science or related field

HS diploma or GED is required

Tools

MS Word

Excel

Database software

Job description

Prime Therapeutics is seeking a Senior Pharmacy Claims Auditor to remotely lead audit initiatives and develop tools, analytics, and training to identify waste and ensure compliance in pharmacy reimbursements.

The role requires a Bachelor’s in Health Science or related field, 5 years in pharmacy with audit/QA, and a PTCB/ExCPT certification. Strong data analysis, cross-functional collaboration, and SME capability are essential.