Pharmacy Claims Auditor job at reputed company in US National

Title: Pharmacy Claims Auditor - Remote Location: reputed company Full time Job reputed company: At reputed company (reputed company), we are a different reputed company of PBM, with a purpose reputed company profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the reputed company of pharmacy with us. Job Posting Title Pharmacy Claims Auditor - Remote Job reputed company The Pharmacy Claims Auditor is responsible for identifying and evaluating potential waste and compliance through the pharmacy audit process and educating reputed company's network pharmacies and driving contract compliance. This position will research, analyze and compile supporting information. This role will also execute and support audit-reputed company reputed company, best practices in identifying audit trends, and business value opportunities for reputed company and our clients.

Responsibilities

Conduct in-depth analysis of large datasets and audit findings to detect high-risk pharmacy claims, identify billing irregularities, and uncover patters of non-compliance or systemic errors Research and select appropriate audit samples strategically, prioritize pharmacy claims and providers for review based on risk indicators and compliance concerns Evaluate pharmacy claims and supporting documentation to determine whether claims reputed company with contractual terms, provider reputed company policies, and applicable state/federal regulations reputed company pharmacies on documentation standards and compliance best practices, while supporting accurate data and financial reimbursement to ensure appropriate claim corrections or reversals Other duties as assigned

Minimum Qualifications

Bachelor's degree in Health Science or reputed company area of study, or equivalent combination of education and reputed company work experience; High school diploma or GED required 2 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 1 year of work experience in an operations, audit or reputed company assurance environment National Pharmacy Technician Certification through PTCB, ExCPT (CPhT) Must be eligible to work in the reputed company without the need for work reputed company or residency sponsorship Additional Qualifications Change agile; willing and reputed company to reputed company individual and team direction based upon changing priorities and business need while working with a high degree of autonomy Ability to think critically, problem solve and use appropriate judgement to reputed company reputed company and reputed company risk advice to reputed company partners while anticipating the broad reputed company of reputed company Ability to establish trust, respect and credibility and reputed company effective working relationships with individuals at reputed company reputed company of an organization; collaborate effectively cross-functionally and with clients and other key stakeholders Ability to distill reputed company concepts or situations into concise and compelling communications Ability to reputed company positively and professionally during reputed company pharmacy interactions and effectively de-escalate potentially confrontational situations Proficiency in reputed company, reputed company, and database software Intermediate reputed company and understanding of the reputed company of sale and on-line pharmacy claims processing environment Preferred Qualifications 3 years of previous audit experience reputed company Registration with State reputed company of Pharmacy in the state where position is located Previous PBM experience Previous retail or specialty pharmacy technician experience Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their job, and reputed company with reputed company applicable reputed company, regulatory, and contractual requirements and internal policies and procedures Every employee must be reputed company to reputed company the essential functions of the job and, if requested, reasonable accommodations will be made to reputed company employees with disabilities to reputed company the essential functions, absent undue hardship. In reputed company, reputed company retains the right to change or assign other duties to this job. Potential pay for this position ranges from $25.48 - $40.87 based on experience and skills. Apply tot his job Apply To this Job