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About the role
- Pharmacy Claims Auditor examining pharmacy claims accuracy for healthcare clients. Conducting audits and ensuring compliance with regulations.
Responsibilities
- Examining and interpreting pharmacy records against submitted claim data for potential discrepancies.
- Utilizing specific client instructions, federal and state regulations, and standards of practice to properly access pharmacy documentation.
- Researching board of pharmacy regulations, and state/federal laws as they relate to prescription requirements and pharmacy practices.
- Responding to pharmacy calls regarding audit results and dealing with clients periodically to report audit results.
- Conducting Onsite and Desktop and Credentialing Audits in a professional and respectful manner.
- Using prescription knowledge to review pharmacy submitted documentation against submitted claim data.
- Assessing and producing detailed descriptions of pharmacy operations and procedures.
- Making confirmation calls to pharmacies prior to audit date and personally handling audit reschedules.
- Performing other duties and responsibilities as assigned
Requirements
- Have National CPhT Certification through the Pharmacy Technician Certification Board (PTCB). Or be able to obtain one within the first few months.
- Have extensive “retail” pharmacy experience.
- Be living in commutable distance to the assigned territory (San Antonio TX)
- Have valid driver's license and have a reliable car to visit pharmacies for audits in the local geography.
- Be able to travel overnight/flight 1 week/month (25%).
- Be proficient with Windows and Microsoft Office.
- Be able to stand for long periods of time (Up to 8 hours).
- Be able to lift heavy boxes (about 20 lbs.) containing prescription records. (Most records are electronic.)
Benefits
- Health & Welfare Benefits: Comprehensive plans tailored to your needs, effective from day one.
- Retirement Savings: Robust programs to help you secure your financial future.
- Employee Discounts: Access to a wide range of discounts on merchandise, services, travel, and more.
- Career Growth Opportunities: Paths for advancement within a global organization.
- Paid Training: Learn while you earn with award-winning learning platforms.
- Paid Time Off: Competitive PTO packages to help you recharge.
- Great Work Environment: Join an award-winning culture that values diversity and inclusion.
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