Pharmacy Audit and Compliance Analyst Job Bethlehem area,Pennsylvania USA,Business

Job Overview

Pharmacy Audit and Compliance Analyst responsible for payer audits, audit‑related recoveries, network risk identification, assessment, reporting and remediation. Provides audit assistance and tools to customers and oversees compliance risk monitoring mechanisms.

Location

Remote, USA

Responsibilities

Track, trend, and coordinate all incoming Payer audit correspondence including onsite, desktop, invoice audit notifications, discrepancy reports, corrective actions, and recoveries.

Provide expert audit assistance to customers, including proactive audit prevention tips, pre‑audit preparation guidance, and support; recommend means of obtaining, analyzing, and evaluating evidentiary data to support the appeal of discrepant claims and assist with coordination of corrective actions taken by a payer.

Conduct enhanced screening of prospective customers seeking Network affiliation using internal and external resources.

Identify high‑risk accounts via pharmacy performance analytics, Central Pay, and other resources.

Collaborate with Sales, Central Pay, Membership, Legal, CSRA, AR, and Credit to identify high‑risk accounts.

Maintain good working relationships with internal and external partners.

Acquire knowledge of industry audit trends and compliance requirements.

Complete special projects as assigned.

Perform related duties as assigned.

Education & Experience

Requires completion of a four‑year bachelor’s degree program or an equivalent combination of experience and education. Generally requires a minimum of four (4) years of experience, with prior pharmacy background required. Strong knowledge of third‑party billing and experience with private health plans and government programs required. Experience with pharmacy audits, pharmacy compliance, and risk mitigation is a plus. Certified or State‑licensed Pharmacy Technician preferred.

Skills

and Knowledge

Excellent organizational skills.

Excellent customer service skills.

Ability to multitask and remain flexible in a fast‑paced work environment.

Ability to communicate effectively both orally and in writing.

Exceptional interpersonal abilities.

Ability to work independently with general direction.

Strong analytical skills; attention to detail.

Strong computer skills, including Microsoft Office, especially Access and Excel.

Benefits

Cencora offers compensation, benefits, and resources that support a highly inclusive culture. Benefits include medical, dental, vision care, backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, paid caregiver leave, and opportunities for training, professional development, mentorship programs, employee resource groups, and volunteer activities.

Full‑time Salary Range

$48,200 – $96,360 (national average; may vary by location).

Equal Employment Opportunity

Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status, or membership in any other class protected by federal, state, or local law. Harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions, and transfers comply with equal opportunity principles and are non‑discriminatory.

Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process.

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