PHARMACY AUDIT SPECIALIST LOCATION

Remote - United States

COMPENSATION & SCHEDULE

$62.00 per hour Monday-Friday, 8:30 AM-5:00 PM EST Coverage assignment: October 7, 2026-November 20, 2026 ROLE IMPACT The Pharmacy Audit Specialist serves as the primary operational resource for managing pharmacy benefit manager (PBM), payer, and payment integrity audits from intake through closure. This role manages a high-volume environment of more than 1,700 audit requests annually while ensuring responses meet contractual, regulatory, and payer requirements. Success is defined by timely and accurate audit responses, effective appeal support, complete documentation, and reduced recoupment and revenue risk.

KEY RESPONSIBILITIES

Receive, review, log, and track PBM, payer, prescription validation, desk, field, real-time, and payment integrity audits through completion Review pharmacy claims, prescriptions, shipping records, and supporting documentation for accuracy and prepare complete audit response packages Research audit findings and recoupments and support audit appeals, scope objections, and recoupment disputes using applicable payer requirements and pharmacy audit regulations Monitor deadlines, audit outcomes, appeal results, and financial exposure while escalating significant compliance, operational, or revenue risks Partner with pharmacy operations, compliance, revenue cycle, accreditation, and leadership teams to improve audit readiness and reduce future audit exposure

LICENSES & CERTIFICATIONS

Certified Pharmacy Technician (CPhT) certification preferred Knowledge of URAC and/or Accreditation Commission for Health Care (ACHC) specialty pharmacy accreditation standards preferred

CLINICAL SKILL SET PBM

audits and payer operations Prescription validation and pharmacy claims review Payment integrity and revenue integrity Audit appeals and recoupment disputes State pharmacy audit regulations PBM provider manuals and payer requirements Audit documentation and deadline management Microsoft Excel, Word, and Outlook Audit reporting, trend analysis, and dashboards

MINIMUM QUALIFICATIONS

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 Advanced Microsoft Excel, Word, and Outlook proficiency with strong analytical, organizational, written communication, and problem-solving skills

PREFERRED SKILLS

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, objections, and recoupment disputes

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