Pharmacy Audit Specialist

KabaFusion•Novi, MI

About The Position

We’re looking for a highly skilled Pharmacist Audit Specialist to take ownership of pharmacy insurance audits across our growing organization. This role sits at the intersection of pharmacy operations, reimbursement, nursing, compliance, and payer strategy - and plays a direct role in protecting revenue and minimizing risk. You’ll lead complex PBM, commercial payer, Medicare, and Medicaid audits tied to infusion therapies, using your deep understanding of home infusion workflows, billing rules, HCPCS/J‑codes, and medical necessity documentation to deliver strong, disciplined audit responses. If you thrive in fast‑paced environments, enjoy digging into complex data, and want your expertise to make a measurable impact, this role was built for you.

Requirements

Bachelor of Science in Pharmacy or Doctor of Pharmacy (PharmD) from an accredited college of pharmacy required.
Active, unrestricted pharmacist license in at least one U.S. state required.
Minimum of 5 years of pharmacy experience with significant exposure to billing, reimbursement, and insurance audits.
In-depth, knowledge of Pharmacy billing, reimbursement, and insurance aduits.

Nice To Haves

Previous ownership (full or partial) of a licensed pharmacy preferred.
Prior experience with PBM/payer audits, or audit appeals strongly preferred.

Responsibilities

Own the audit process for home and specialty infusion pharmacy services - from intake through final resolution - across PBM, commercial, Medicare, and Medicaid audits.
Defend claims with confidence, reviewing infusion orders, compound records, HCPCS/J‑codes, nursing documentation, plans of care, inventory records, and medical necessity support.
Evaluate real‑world infusion operations, identifying documentation, billing, or workflow gaps that create audit or recoupment risk.
Prepare and submit audit responses, appeals, rebuttals, and corrective action plans that are tight, defensible, and payer‑ready.
Analyze audit outcomes to identify trends, root causes, and revenue exposure - and turn findings into actionable improvements.
Partner cross‑functionally with pharmacy operations, nursing leadership, reimbursement, compliance, and legal to close gaps and prevent repeat findings.
Build infusion‑specific audit readiness, including standardized documentation practices and internal compliance playbooks.
Educate and influence pharmacists, nurses, billing teams, and leaders on payer expectations and audit best practices.
Stay ahead of the curve, maintaining expert‑level knowledge of infusion reimbursement models, payer contracts, Medicare Part B/Part D, Medicaid requirements, and audit methodologies.