Pharmacy Claims Auditor, CPhT

• Examine and interpret pharmacy records against submitted claim data for discrepancies
• Apply client instructions, federal and state regulations, and standards of practice when accessing pharmacy documentation
• Research board of pharmacy regulations and state/federal laws related to prescription requirements and pharmacy practices
• Respond to pharmacy calls about audit results
• Report audit results to clients periodically
• Conduct onsite, desktop, and credentialing audits professionally and respectfully
• Review pharmacy-submitted documentation against claim data using prescription knowledge
• Assess and produce detailed descriptions of pharmacy operations and procedures
• Make confirmation calls to pharmacies before audit dates
• Handle audit reschedules
• Perform other assigned duties

• National CPhT Certification through the Pharmacy Technician Certification Board (PTCB), or ability to obtain it within the first few months
• Extensive retail pharmacy experience
• Living within commutable distance of the assigned territory:
  New Orleans, LA;
  Charlotte, NC;
  Louisville, KY;
  St. Louis, MO;
  Indianapolis, IN; or Cincinnati, OH
• Valid driver's license and reliable car for visiting pharmacies
• Ability to travel overnight/by flight one week per month (25%)
• Proficiency with Windows and Microsoft Office
• Ability to stand for long periods, up to 8 hours
• Ability to lift approximately 20-pound boxes containing prescription records

Demonstrates expertise in pharmacy operations and compliance with federal and state regulations, alongside strong auditing skills and the ability to communicate effectively with pharmacy personnel. Proficient in analyzing pharmacy records and claim data to ensure accuracy and adherence to standards.

• National CPhT Certification
• Retail Pharmacy Experience
• Pharmacy Auditing
• Regulatory Compliance
• Microsoft Office Proficiency

• Pharmacy Record Examination
• Claim Data Analysis
• Audit Reporting
• Prescription Knowledge
• Detailed Documentation Assessment

• Professional Communication
• Respectful Interaction
• Problem-Solving

• National CPhT Certification

• Pharmacy Regulations
• State/Federal Laws
• Audit Procedures
• Credentialing Audits
• Pharmacy Operations

• Windows
• Microsoft Office