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
[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.