Pharmacy Audit Lead
About The Position
The Pharmacy Audit Lead is a player-coach who conducts pharmacy audits while leading the team’s daily work. The role assigns and monitors audit work, manages quality and escalations, supports disputes and recoveries, and maintains the reporting and administrative controls needed to meet client commitments and plan capacity. The position is hybrid and local to New York, NY; Denver, CO; or Charlotte, NC. The Pharmacy Audit Lead partners with internal teams and clients, serves as a pharmacy audit subject matter resource, and uses audit results and operating metrics to improve workflows, controls, systems, turnaround times, and team efficiency. Employees are responsible for adhering to the Judi Health Code of Conduct, including reporting non-compliance. Duties may be reassigned as needed to meet organizational goals.
Requirements
- Active pharmacy technician certification or registration.
- Four to six years of pharmacy or PBM auditing experience, including direct pharmacy audits and team lead experience.
- Strong knowledge of pharmacy operations, billing, audit and documentation requirements, and pharmacy contracts.
- Strong analytical, organizational, problem-solving, documentation, communication, and prioritization skills.
- Proficiency in Microsoft Excel, Word, and applicable audit, workflow, and reporting tools.
- Bachelor's degree in Business, Accounting, Healthcare Administration, or a related field preferred, or equivalent relevant experience.
Nice To Haves
- Active pharmacist license preferred.
Responsibilities
- Assign, rotate, and prioritize audit work; set expectations and maintain operating standards.
- Monitor inventory, productivity, deadlines, quality, capacity, and staffing needs; resolve barriers and escalate risks.
- Lead team huddles and case reviews; coach and train staff; and serve as the first escalation point for audit and workflow issues.
- Maintain pharmacy audit SOPs, procedures, job aids, and templates, including version control and scheduled reviews.
- Personally conduct pharmacy audits, including claims and documentation review.
- Validate findings, evidence, recovery calculations, reports, and correspondence before finalization.
- Manage audit inventory, daily claims review, deadlines, disputes, appeals, recoveries, vendor work, and client deliverables.
- Prepare audit reports, trend summaries, and client or management materials.
- Use audit results and operational metrics to improve workflows, controls, systems, turnaround times, and team efficiency.
- Maintain reporting for inventory, productivity, quality, recoveries, deadlines, and capacity; support practical system or automation improvements.
- Serve as the pharmacy audit subject matter resource for clients and internal partners.
- Partner across Compliance, Legal, Client Services, Provider Relations, Payment Integrity, Finance, Product, Commercial, and technology; escalate risks and suspected fraud, waste, abuse, or intentional misconduct.
- Support workload forecasting, staffing assessments, insourcing readiness, and product or commercial initiatives with audit and capacity data.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
