Pharmacy Audit Specialist

Come join an exciting and innovative company that puts the "care" back in healthcare! At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn't matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

About Us:

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it's no wonder why KabaFusion is the industry leader in home infusion. About the Role We're looking for a highly skilled Pharmacist Audit Specialist to take ownership of pharmacy insurance audits across our growing organization. This role sits at the intersection of pharmacy operations, reimbursement, nursing, compliance, and payer strategy - and plays a direct role in protecting revenue and minimizing risk. You'll lead complex PBM, commercial payer, Medicare, and Medicaid audits tied to infusion therapies, using your deep understanding of home infusion workflows, billing rules, HCPCS/J‑codes, and medical necessity documentation to deliver strong, disciplined audit responses. If you thrive in fast‑paced environments, enjoy digging into complex data, and want your expertise to make a measurable impact, this role was built for you. What You'll Do Own the audit process for home and specialty infusion pharmacy services - from intake through final resolution - across PBM, commercial, Medicare, and Medicaid audits. Defend claims with confidence , reviewing infusion orders, compound records, HCPCS/J‑codes, nursing documentation, plans of care, inventory records, and medical necessity support. Evaluate real‑world infusion operations , identifying documentation, billing, or workflow gaps that create audit or recoupment risk. Prepare and submit audit responses, appeals, rebuttals, and corrective action plans that are tight, defensible, and payer‑ready. Analyze audit outcomes to identify trends, root causes, and revenue exposure - and turn findings into actionable improvements. Partner cross‑functionally with pharmacy operations, nursing leadership, reimbursement, compliance, and legal to close gaps and prevent repeat findings. Build infusion‑specific audit readiness , including standardized documentation practices and internal compliance playbooks. Educate and influence pharmacists, nurses, billing teams, and leaders on payer expectations and audit best practices. Stay ahead of the curve , maintaining expert‑level knowledge of infusion reimbursement models, payer contracts, Medicare Part B/Part D, Medicaid requirements, and audit methodologies.

Qualifications:

Bachelor of Science in Pharmacy or Doctor of Pharmacy (PharmD) from an accredited college of pharmacy required. Active, unrestricted pharmacist license in at least one U.S. state required. Previous ownership (full or partial) of a licensed pharmacy preferred. Minimum of 5 years of pharmacy experience with significant exposure to billing, reimbursement, and insurance audits. In-depth, knowledge of Pharmacy billing, reimbursement, and insurance aduits. Prior experience with PBM/payer audits, or audit appeals strongly preferred.

What we offer:

Competitive compensation Benefits start on your 1st day of employment 401k w 4% match - no waiting or vesting period PTO / Floating Holidays / Paid Holidays Company paid life insurance, short term disability Employee Assistance programs to help with mental health / wellness Learning & Development Programs Perks… includes discounts on travel, cell phone, clothing and more… Generous employee referral program To learn more about KabaFusion, please visit our careers page: https://www.kabafusion.com/careers/ Join us and find out why this is the place to excel and do your best work.