Pharmacy Auditor I

EXL•United States,

5d•$45,000 - $58,000•Remote

About The Position

EXL Health is hiring a full-time Pharmacy Auditor I for a 100% remote, U.S.-based role. The position conducts pharmacy desk audits and may include onsite or virtual pharmacy audits as assigned. Travel may occur for team meetings or limited client engagements based on business or client needs. The auditor reviews prescription claims and supporting pharmacy documentation to assess compliance with contractual, regulatory, and program requirements, identify discrepancies or potential overpayments, and document findings. The role applies established audit procedures and validation criteria, performs quality reviews, communicates audit status and issues to internal stakeholders, and protects confidential pharmacy and patient information. The posted base salary range is $45,000–$58,000, with final offers based on factors including skills, experience, work location, and role scope.

Requirements

High School Diploma or equivalent.
Certified Pharmacy Technician (CPhT).
Active state pharmacy technician license or registration where required.

Responsibilities

Conduct assigned pharmacy desk audits by reviewing prescription claims and supporting documentation for compliance and potential discrepancies or overpayments.
Review pharmacy records and supporting documentation, including prescription records, signature logs, proof of delivery, invoices, and dispensing records, and document audit findings accurately.
Apply established audit procedures, client requirements, discrepancy codes, and validation criteria to assess claim support and identify potential recoverable findings.
Maintain complete, accurate, and timely audit documentation, case notes, evidence, findings, and status updates in required systems and workflows.
Perform quality review and validation activities to ensure audit findings and supporting documentation are accurate, complete, and consistent with audit requirements.
Conduct onsite or virtual pharmacy audits as assigned, including interacting with pharmacy personnel, reviewing records, collecting evidence, and documenting findings.
Communicate with Audit Coordinators, management, and internal stakeholders about audit status, documentation issues, findings, deadlines, and matters requiring escalation.
Maintain knowledge of applicable pharmacy audit requirements, client policies, pharmacy practices, and relevant state and federal requirements.
Comply with HIPAA, confidentiality, privacy, and information-security requirements when handling pharmacy and patient information.
Meet established productivity, quality, accuracy, and timeliness expectations and perform other pharmacy audit-related duties as assigned.