Pharmacy Auditor I

Audit pharmacy claims in a pre-pay or post-pay status, identifying aberrancies for outreach to pharmacies for education and correction. The auditor will analyze data sets to trend over time identifying outliers of that data set when compared to other pharmacies or standards. Ensuring auditing processes meet all regulatory and client contractual requirements is a must. The candidate will identify trends and events that impact pharmacy and administrative costs, as well as participate in process re-design, system enhancements and automation opportunities for cost reduction. They will summarize, report, and communicate key discoveries and audit results to the team and other departments as needed. This may include written reports. Lastly, the candidate will evaluate audit results for potential referral to our internal Special Investigations Unit (SIU) which may include fraud, waste, and abuse