PBM Audit & Specialty Pharmacy
Listed on 2026-09-30
-
Healthcare
USC/GCNeed Linked In, VISA DL2 months project
Interview Mode:
Teams Video
Work schedule (days & time): must be able to work Monday - Friday 8:30am - 5pm EST Timezone
The Temporary PBM Audit & Appeals Specialist is responsible for the administration and coordination of pharmacy benefit manager (PBM), payer, and payment integrity audits. This role serves as the primary operational resource for receiving, processing, tracking, researching, responding to, and closing audit requests while ensuring compliance with contractual, regulatory, and payer requirements.
The Specialist manages a high-volume audit environment consisting of prescription validation reviews, desk audits, field audits, real-time audits, and other payer review activities. The position also supports preparation of audit appeals, objections to audit scope, documentation collection, and audit outcome tracking designed to minimize recoupment risk and protect organizational revenue. Audit activity exceeds 1,700 requests annually and requires strong organization, regulatory knowledge, and attention to detail.
Primary Responsibilities:Required
- 3+ years of experience in specialty pharmacy, PBM audits, pharmacy compliance, payer operations, revenue integrity, or related healthcare operations.
- Experience reviewing pharmacy claims, prescription documentation, and payer requirements.
- Strong written communication and documentation skills.
- Advanced Microsoft Excel, Word, and Outlook proficiency.
- Ability to manage multiple concurrent deadlines with minimal supervision.
- Strong analytical, organizational, and problem-solving skills.
- Specialty pharmacy experience.
- Experience with PBM audits, payment integrity reviews, or prescription validation audits.
- Familiarity with state pharmacy audit laws and PBM provider manuals.
- Experience developing audit appeals and recoupment disputes.
- Knowledge of specialty pharmacy accreditation standards (URAC and/or ACHC).
$000,000 – $000,000 Salary range is not shown on the candidate portal
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).