Pharmacy Audit & Credential Coordinator (Remote)

Omnicell•Grapevine, TX

3h•Remote

About The Position

The OSPS Credentialing and Audit Coordinator plays a key role in supporting the Client Services team by managing pharmacy credentialing activities, coordinating responses to PBM and third-party audits, and resolving payor-related issues. This role supports compliance, reimbursement optimization, and strategic initiatives across the organization.

Requirements

Certified Pharmacy Technician registration
Minimum of 5 years of experience working in a specialty pharmacy environment
Strong attention to detail with excellent organizational and time management skills
Effective communication and interpersonal skills, including the ability to perform well in high-pressure situations
Ability to manage multiple priorities in a fast-paced environment
Strong analytical and problem-solving skills related to claims and reimbursement issues
Proficiency in Microsoft Office applications
Self-motivated, proactive, and resourceful with strong follow-through
Ability to work independently and collaboratively within a team environment
Professional demeanor with a strong work ethic and commitment to accuracy
Ability to interact effectively with internal teams, clients, and external partners at all levels
Ability to work remotely or in an office environment
Willingness to travel up to 25% as needed

Nice To Haves

2 to 3 years of experience working in a pharmacy dispensing system
Experience with PBM or payor audits

Responsibilities

Support the coordination and timely response to PBM and third-party audits, ensuring all requests are reviewed and addressed within required deadlines
Prepare and organize audit responses and assist with appeal submissions when applicable
Collect, review, and validate audit documentation from pharmacies to ensure accuracy and completeness prior to submission
Assist with PBM-related activities, including MAC appeals, claim rejections, and reimbursement discrepancies
Maintain active pharmacy credentialing with all required entities in compliance with regulatory and contractual requirements
Communicate with PBMs to verify contracted reimbursement rates and initiate appeals as needed
Maintain and audit contract and carrier code data within the third-party reconciliation system to ensure financial accuracy
Manage and analyze the Daily Rejection Report and investigate and resolve third-party claim rejections
Collaborate with Accounting, Finance, and Operations teams to support accurate reporting and resolution of audit findings and pricing discrepancies
Support formal communications with Pharmacy Benefit Managers and Managed Care Organizations
Perform additional duties as assigned to support departmental and organizational objectives