Top 23 Pharmacy claims auditor Jobs in Remote

Pharmacy Claims Auditor Sr - Remote
Prime Therapeutics —Remote
- $59,000 - $94,000 a year
- Full-time
- Remote
- 3 years
- High school diploma or GED
- Bachelor's degree
4d
Manager, Complex Clinical Review
Machinify —Remote
- $115,000 - $130,000 a year
- Remote
- Nursing
- Microsoft Excel
- RN License
- Health insurance
- Dental insurance
4d
DRG Auditor (REMOTE)
EnableComp —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Claims Training Specialist
CorVel Corporation —Folsom, CA
- $77,960 - $120,368 a year
- Full-time
- Remote
- Classroom
- Computer literacy
- HIPAA
- Health savings account
- Disability insurance
Quick Apply
Claims Quality Assurance
CorVel Corporation —Irving, TX
- $70,276 - $116,942 a year
- Full-time
- Remote
- Analysis skills
- Bachelor's degree
- Mentoring
- Health savings account
- Disability insurance
Quick Apply
MAC Appeals Specialist
Polaris Pharmacy Services —Fort Lauderdale, FL
- Extended hours
- Remote
- Mid-level
- High school diploma or GED
- Computer skills
- Paid holidays
- Disability insurance
Quick Apply
11d
Investigator, Special Investigative Unit Coding (Remote)
Molina Healthcare —New York, NY
- $21.82 - $51.06 an hour
- Full-time
- Remote
- Anatomy knowledge
- Clinic experience
- Research
- Health insurance
12d
Evaluation and Management Medical Coder/Auditor
Optum —Plymouth, MN
- $20 - $36 an hour
- Overtime
- Remote
- Microsoft Word
- Microsoft Outlook
- Pass drug screening
- Paid training
- AD&D insurance
Payment Integrity Program Development Manager
Devoted Health —Remote
- $73,000 - $120,000 a year
- Full-time
- Remote
- SQL
- Analysis skills
- Bachelor's degree
- Dental insurance
- 401(k)
Benefit Analyst III
WellDyne —Remote
- Remote
- Research
- Mid-level
- Office
Quick Apply
Senior Medical Coder
Optum —Chelmsford, MA
- $24 - $43 an hour
- Full-time
- Remote
- Urgent Care
- Pass drug screening
- No high school diploma
Plan Coder
WESTERN GROWERS ASSURANCE TRUST —Irvine, CA
- $46,669.19 - $60,668.60 a year
- Full-time
- Remote
- Computer Science
- Bachelor of Science
- Writing skills
Quick Apply
Clinical Operations Supervisor
Sagility —Remote
- Call employer
- Remote
- Nursing
- RN License
- HIPAA
Manager, Insurance Accounting
Frontdoor —Remote
- $105,000 - $130,000 a year
- Full-time
- CPA
- Office
- Finance
- Employee stock purchase plan
- Disability insurance
Clinical Review Supervisor
CorVel Corporation —Fort Worth, TX
- $77,960 - $120,368 a year
- Full-time
- Remote
- HIPAA
- Mid-level
- Supervising experience
- Health savings account
- Disability insurance
Quick Apply
5d
Staff Accountant
BIRDI, INC —Plymouth, MI
- Extended hours
- Remote
- Mid-level
- Finance
- Analysis skills
Quick Apply
11d
Hybrid Pharmacist - 4 Days Retail/1 Day Remote (TN)
Walgreens —Remote
- Hybrid work
- Bachelor of Science
- Mid-level
- Organizational skills
- Paid parental leave
- Health insurance
Hybrid Pharmacist - 4 Days Retail/1 Day Remote (NC)
Walgreens —Remote
- Hybrid work
- Bachelor of Science
- Mid-level
- Organizational skills
- Paid parental leave
- Health insurance
Hybrid Pharmacist - 4 Days Retail/1 Day Remote (MO)
Walgreens —Remote
- Hybrid work
- Bachelor of Science
- Mid-level
- Organizational skills
- Paid parental leave
- Health insurance
Senior Accountant - Pharmacy (REMOTE)
SCAN Health Plan —Long Beach, CA
- $92,400 - $133,671 a year
- Full-time
- Remote
- Microsoft Word
- Background check
- Microsoft Outlook
- Wellness program
- Paid holidays
Quick Apply

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pharmacy claims auditor jobs near remote

Pharmacy Claims Auditor Sr - Remote

Prime Therapeutics -
Remote

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Job Details

Full-time
$59,000 - $94,000 a year
4 days ago

Qualifications

Employee relationship building
High school diploma or GED
Registered Pharmacy Technician

Full Job Description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Pharmacy Claims Auditor Sr - Remote

Job Description

The Senior Pharmacy Claims Auditor is responsible for providing education, training and guidance to identify and evaluating potential waste and compliance through the pharmacy audit process. This position leads the development and enhancement of audit tools, analytics, processes, and training to effectively identify erroneous claims, non-compliant pharmacy practices or potential improper pharmacy reimbursements. This role will execute and support audit-related initiatives, leveraging best practices to identify emerging audit trends and uncover business value opportunities for Prime and its clients.

Responsibilities

Collaborate with cross-functional teams to identify, develop, deliver, and support training focused on trend analysis, audit planning, procedures, and system process, along with identifying technology enhancement opportunities
Provide guidance and operational support to the Pharmacy Audit Operations team, promoting best practices, leading projects, and resolving issues
Analyze claim and audit data to support ongoing audit analytic efforts, identify trends and refinements; collaborate with other department staff to create enhanced reporting and represent audit team as the Subject Matter Expert (SME) for system enhancement initiatives and testing
Other duties as assigned

Minimum Qualifications

Bachelor's degree in Health Science or related area of study, or equivalent combination of education and related work experience; HS diploma or GED is required
5 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and Pharmacy Benefit Management experience to include 3 years of work experience in audit or quality assurance
National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

Change agile; willing and able to adjust individual and team direction based upon changing priorities and business need while working with a high degree of autonomy
Ability to think critically, problem solve and use appropriate judgement to make decisions and provide risk advice to internal and external partners while anticipating the broad impact of decisions
Ability to establish trust, respect and credibility and form effective working relationships with individuals at all levels of an organization; collaborate effectively cross-functionally and with clients and other key stakeholders
Ability to distill complex concepts or situations into concise and compelling communications
Ability to effectively de-escalate potentially confrontational situations
Proficiency in MS Word, Excel, and database software
Demonstrated skill and understanding of the point of sale and on-line pharmacy claims processing environment

Preferred Qualifications

5 years of previous audit experience
Current Registration with State Board of Pharmacy in the state where position is located
Previous PBM experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Apply Now

Refine Your Search

pharmacy claims auditor jobs in remote

Pharmacy Claims Auditor Sr - Remote

Manager, Complex Clinical Review

DRG Auditor (REMOTE)

Claims Training Specialist

Claims Quality Assurance

MAC Appeals Specialist

Investigator, Special Investigative Unit Coding (Remote)

Evaluation and Management Medical Coder/Auditor

Payment Integrity Program Development Manager

Benefit Analyst III

Senior Medical Coder

Plan Coder

Clinical Operations Supervisor

Manager, Insurance Accounting

Clinical Review Supervisor

Staff Accountant

Hybrid Pharmacist - 4 Days Retail/1 Day Remote (TN)

Hybrid Pharmacist - 4 Days Retail/1 Day Remote (NC)

Hybrid Pharmacist - 4 Days Retail/1 Day Remote (MO)

Senior Accountant - Pharmacy (REMOTE)

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