DescriptionWe’re searching for a Pharmacy Claims Auditor, someone who’s ready to be part of the best ranked children’s hospital in Texas, and among the best in the nation. In this position, you will help oversee the daily operations of pharmacy claims, Pharmacy Benefit Manager (PBM) audits, monitoring pharmacy adjudication trends and team education.
Think you’ve got what it takes?
Job Duties & Responsibilities
- Assists in the operations for the Pharmacy through audit management
- Oversees pharmacy payor directed audits by collecting transactional records and informational data, submitting data by deadlines.
- Maintains audit records to track recovery amounts.
- Ensure PBM auditing processes meet all regulatory and client contractual requirements.
- Provide audit trending report to leaders and internal stakeholders.
- Routine Adjudication Monitoring
- Summarize, report, and communicate key discoveries and audit results to the team and other departments as needed.
- Provides insurance navigation, rejection and technical difficulty education to team.
- Build and maintain relationships with internal business units and pharmacy service providers.
- Performs other essential functions.
As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards.
Skills & Requirements
- H.S. Diploma or GED Required
- RPHT-TX - Reg Pharmacy Technician by the TX State Board of Pharmacy required
- CPHT - Cert-Pharm. TECH Certification by the Pharmacy Technician Certification Board preferred
- 2 years pharmacy technician experience preferred
- 1 year pharmacy (PBM) adjudication experience preferred