Pharmacy Audit Specialist

Job Description

Job Description

Description:

SUMMARY

The Pharmacy PBM Audit Specialist supports the compliance team in responding to Pharmacy Benefit Managers (PBM) and third-party payer audits. This position is ideal for pharmacy technicians or individuals with pharmacy operations experience who are detail-oriented, organized, and eager to build a career in pharmacy compliance.

The specialist assists with gathering documentation, reviewing claims, and maintaining accurate records to ensure compliance with PBM and regulatory requirements.

ESSENTIAL FUNCTIONS

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Predictable, reliable, and punctual attendance is an essential function of the job role.

KEY RESPONSBILITIES

• • Assist in preparing responses for PBM desk audits, onsite audits, and claim reviews
• • Collect prescription hard copies, delivery confirmations, and all other supporting documentation
• • Ensure documents are complete, accurate, and submitted within required timelines
• • Scan, organize, and maintain audit files in pharmacy software
• • Track active audits and maintain detailed audit logs
• • Assist with reconciliation of audit results and identification of discrepancies
• • Partner with pharmacy operations, billing, and compliance staff to gather required information
• • Report potential risks or documentation issues to compliance leadership
• • Support quality assurance projects that reduce audit risks
• • Participate in training to expand knowledge of PBM contracts, claims, and compliance best practices
• • Contribute ideas to strengthen audit readiness and compliance processes

MINIMUM REQUIREMENTS

Education & Experience:

• High School Diploma or GED required.
• NJ Pharmacy Technician License required
• Certified Pharmacy Technician (CPhT) preferred.
• 1+ year experience as a pharmacy technician or in pharmacy operations preferred
• Familiarity with PBM processes or healthcare auditing is a plus but not required
• Strong attention to detail and document accuracy
• Ability to manage multiple priorities with tight deadlines
• Effective communication and teamwork skills
• Proficiency with Microsoft Office, pharmacy software and electronic record systems

PHYSICAL DEMANDS

• Ability to sit and work at a computer for extended periods.
• Frequent use of hands for typing, writing, and handling documents.
• Occasional lifting of audit files, boxes, or binders (up to 20 pounds).
• Occasional standing, walking, bending, or reaching while retrieving physical records
• Ability to focus on detailed work and manage multiple priorities in a fast-paced environment.