Pharmacy Auditor

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers unions health plans and government entities. Judi Health replaces fragmented outdated systems with the industry s first Unified Claims Processing™ architecture seamlessly consolidating pharmacy and medical benefit administration on a single secure platform. By delivering true price transparency eliminating unnecessary middleman fees and leveraging advanced AI-powered care delivery Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health we re deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more visit a www.judi.health.

Location Hybrid (Local to NYC Denver or Charlotte areas):true:true:2

Position Summary

The Pharmacy Auditor is responsible for conducting comprehensive audits of network pharmacies to ensure compliance with contractual obligations regulatory requirements client expectations and industry standards. This role evaluates the accuracy of pharmacy claims prescription dispensing practices inventory records and supporting documentation to identify billing discrepancies recover overpayments and promote program integrity.

The Pharmacy Auditor plays a critical role in safeguarding healthcare resources by identifying operational billing and compliance risks within the pharmacy network. This position collaborates closely with Compliance Legal Finance Provider Relations Clinical and Fraud Waste and Abuse (FWA) teams to support corrective actions recoveries regulatory requirements and education initiatives.

Position Responsibilities

Conduct desk remote and on-site pharmacy audits to evaluate pharmacy compliance with contractual regulatory and operational requirements. Review prescription records claims data purchase invoices inventory documentation dispensing logs and other supporting records to validate the accuracy and legitimacy of billed claims. Analyze pharmacy claims and utilization data to identify potential discrepancies billing irregularities overpayments and areas of non-compliance. Calculate and document audit findings and financial recoveries in accordance with established audit methodologies client requirements and applicable laws and regulations. Prepare clear accurate and comprehensive audit reports outlining findings root causes financial impact and recommended corrective actions. Communicate audit observations findings and recovery determinations to pharmacies and internal stakeholders in a professional and effective manner. Monitor corrective action plans and follow-up activities to ensure resolution of identified deficiencies. Collaborate with Special Investigations Unit personnel when audit findings indicate potential fraud waste or abuse concerns requiring further review. Support regulatory examinations client audits grievance investigations appeals and special projects as assigned. Maintain thorough documentation in accordance with audit standards organizational policies and record retention requirements. Stay current on applicable federal and state pharmacy regulations CMS requirements NCPDP standards PBM policies and industry best practices. Participate in the development and enhancement of audit methodologies policies procedures and reporting processes. Assist with training and education initiatives for internal teams and network pharmacies regarding audit findings and compliance expectations.

Required Qualifications

Education

Bachelor s degree in Healthcare Administration Business Administration Pharmacy Accounting Finance or a related field preferred. Certified Pharmacy Technician (CPhT) designation strongly preferred. Additional certifications related to auditing compliance healthcare fraud investigation or pharmacy operations are a plus.

Experience

Two (2) to five (5) years of experience in pharmacy auditing PBM operations pharmacy compliance healthcare auditing pharmacy practice or a related field required. Experience reviewing pharmacy claims prescription documentation inventory records and third-party billing processes preferred. Working knowledge of pharmacy benefit management operations Medicare Medicaid and commercial pharmacy benefit programs preferred. Experience utilizing audit reporting and data analytics tools to identify trends anomalies and recovery opportunities preferred.

Knowledge Skills and Abilities

analytical investigative and problem-solving skills with the ability to identify complex billing and compliance issues. Exceptional attention to detail and accuracy in reviewing documentation and preparing audit reports. Ability to interpret contracts policies regulations and audit standards. written and verbal communication skills with the ability to effectively present findings to both internal and external stakeholders. Excellent organizational and time-management skills including the ability to manage multiple audits and competing priorities simultaneously. Proficiency in Microsoft Office Suite particularly Excel Word PowerPoint and data analysis tools. Ability to maintain confidentiality and exercise sound professional judgment when handling sensitive information. Demonstrated ability to work independently while collaborating effectively within a cross-functional team environment.

Physical and Travel Requirements

Ability to travel periodically for on-site pharmacy audits and business-related meetings as needed. Ability to work in a hybrid environment and perform work primarily using standard office technology and equipment.

New York NY Salary Range $65,000 $80,000 USD

Denver CO Salary Range $65,000 $80,000 USD

Charlotte NC Salary Range $65,000 $80,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race color religion age sex national origin disability status medical condition genetic information protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.:false:false:0

:false:false:0 By submitting an application you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health s privacy practices can be found at a https://www.judi.health/legal/privacy-policy.