Pharmacy Auditor I

EXL Health is hiring a Pharmacy Auditor I. This is a full-time, work from home opportunity.

Responsibilities

Salary Range: $45,000-$58,000 (based on experience, skills, and qualifications)

Location: 100% Remote (US Based)

Up to 10% annual travel (for team meetings and limited client onsite engagements)

For more information on benefits and what we offer, please visit us at https://www.exlservice.com/us-careers-and-benefits

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.

Qualifications

Education and Certification:

High School Diploma or Equivalent

Certified Pharmacy Technician (CPhT) and active state pharmacy technician license/registration where required

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.