Pharmacy Audit Support Representative
HCM Nexus ConsultingJob Description
About the Role
We are seeking a Pharmacy Audit Support Representative to join our team. This role is responsible for reviewing and analyzing pharmacy claims to ensure compliance with regulations and company standards. The position involves working closely with pharmacy providers, verifying claims data, identifying discrepancies, and supporting audit processes to maintain the accuracy and integrity of our claims systems.
Key Responsibilities
Review pharmacy claims against company policies and regulatory guidelines to identify errors or potential fraud.
Communicate with pharmacy providers to verify billing details and request claim adjustments when necessary.
Document audit support findings, prepare reports, and maintain accurate records of communications.
Review prescriptions, dispensing activities, and supporting documents for billing accuracy.
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