Independence Blue Cross
Pharmacy Claims Auditor (Remote)
This job is now closed
Job Description
- Req#: 6565
Employer Industry: Health Insurance
Why consider this job opportunity:
- Fully remote position, allowing for work flexibility within the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
- Opportunity for career advancement and growth within the organization.
- Competitive salary and comprehensive benefits package.
- Supportive and collaborative work environment focused on enhancing community health and well-being.
- Chance to make a significant impact by detecting and preventing fraud, waste, and abuse in healthcare.
What to Expect (Job Responsibilities):
- Conduct audits of claims submitted to the employer to ensure accuracy of provider payments and charges.
- Analyze provider billing patterns to detect potential fraud, waste, or abuse.
- Perform audits through daily reviews, live audits, and desk audits to identify inappropriate billing practices.
- Review and verify provider billing records, collaborating with audit analysts, auditors, and investigators.
- Initiate and validate claim adjustments, maintain comprehensive audit documentation, and prepare statistical reports.
What is Required (Qualifications):
- Certified Pharmacy Technician (CPhT) required.
- Minimum of four (4) years of relevant experience, including at least two (2) years in retail or hospital pharmacy and two (2) years in pharmacy audit.
- Extensive understanding of healthcare provider audit practices and medical terminology.
- Strong written and verbal communication skills for reporting and presenting audit findings.
- Proficiency in Microsoft Office applications, including advanced Excel skills (pivot tables, VLOOKUP, data analysis).
How to Stand Out (Preferred Qualifications):
- Experience with pharmacy claims systems such as RxTrack and RxClaim is preferred but not required.
#HealthInsurance #RemoteWork #PharmacyAudit #CareerAdvancement #FraudDetection
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Independence Blue Cross is a health insurer based in Philadelphia, Pennsylvania, in the United States.
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