Examining and interpreting pharmacy records against submitted claim data for potential discrepancies.
Utilizing specific client instructions, federal and state regulations, and standards of practice to properly access pharmacy documentation.
Researching board of pharmacy regulations, and state/federal laws as they relate to prescription requirements and pharmacy practices.
Responding to pharmacy calls regarding audit results and dealing with clients periodically to report audit results.
Conducting Onsite and Desktop and Credentialing Audits in a professional and respectful manner.
Using prescription knowledge to review pharmacy submitted documentation against submitted claim data.
Assessing and producing detailed descriptions of pharmacy operations and procedures.
Making confirmation calls to pharmacies prior to audit date and personally handling audit reschedules.
Performing other duties and responsibilities as assigned

Have National CPhT Certification through the Pharmacy Technician Certification Board (PTCB). Or be able to obtain one within the first few months.
Have extensive “retail” pharmacy experience.
Be living in commutable distance to the assigned territory (Philadelphia, PA)
Have valid driver's license and have a reliable car to visit pharmacies for audits in the local geography.
Be able to travel overnight/flight 1 week/month (25%).
Be proficient with Windows and Microsoft Office.
Be able to stand for long periods of time (Up to 8 hours).
Be able to lift heavy boxes (about 20 lbs.) containing prescription records. (Most records are electronic.)

Pharmacy Claims Auditor, CPhT

About this role