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Pharmacy Bill Auditor

The role of the Pharmacy Bill Auditor is to ensure that filled prescriptions are billed in accordance with the negotiated insurance rates. They will work closely with assigned pharmacies to certify that prescriptions are dispensed and claims are filed within the appropriate state’s rules and regulations.

Job Duties:

  • Visit assigned pharmacies and perform announced or unannounced billing audits of previously filed claims
  • Perform remote mini audits to encourage continued compliance
  • Observe pharmacist to ensure they are dispensing medication within guidelines
  • Inspect inventory and pharmacy computer programs for accuracy and discrepancies
  • Ensure all equipment is in proper working order and in compliance with industry standards
  • Investigate inquiries into claims to determine the nature of errors

Requirements:

  • Bachelor’s degree in Business or other health care related field
  • Pharmacy Technician certification with an accredited certifying body
  • In depth knowledge of the health insurance process
  • Background in medical billing and pharmacy operations
  • Basic computer skills and knowledge of Microsoft Office suite required
  • Ability to communicate effectively with peers and pharmacy employees