Location: Hybrid (Local to New York, NY, Denver, CO or Charlotte, NC)

Position Summary

The Pharmacy Audit Lead is a player-coach who performs 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.

Position 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.

Required Qualifications:

• Bachelor's degree in Business, Accounting, Healthcare Administration, or a related field preferred, or equivalent relevant experience.
• Active pharmacy technician certification or registration required.
• 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.

Preferred Qualifications:

• Active pharmacist license preferred.