Claims Quality Auditor jobs in Boston, MA

We are looking for a Pharmacy Claims Auditor to perform a variety of pharmacy audit duties. To succeed in this role, you should be an exceptional communicator with an analytical mind, attention to detail and sound judgement.

Responsibilities

• Schedule and prepare for onsite audit trips
• Review pharmacy prescriptions for compliance to State and Federal regulations
• Enter potential discrepancies into the IPS audit software
• Complete store credentialing worksheet
• Collect signature log verifications
• Explain audit findings and recommend solutions

Skills

• Knowledge of the most common medications and usual dosages
• Understanding of methods of filling prescriptions and submitting claims
• Experience with third party (insurance) billing procedures
• Interpreting prescriptions accurately
• Ability to analyze large amount of pharmacy claims data
• Awareness of pharmacy prescription laws and regulations
• Attention to details, accuracy and quality
• Computer proficient in Microsoft Office products as well as pharmacy computer systems
• Excellent verbal and written communication skills
• Sound judgement and decision-making ability
• Strong organizational skills
• Keen attention to detail

Ideal candidates must be able to work independently, be self-motivated, have good organizational skills and excellent customer service skills. Ability to identify issues, investigate matters and creatively work to resolve unexpected and unanticipated problems. Travel is required.

Qualified candidates must be a registered Pharmacy Technician in Massachusetts and ideally have 2 plus years’ experience as a Nationally Certified Pharmacy Technician.

Job Type: Full-time

Pay: $54,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Relocate:

• Melrose, MA: Relocate before starting work (Required)

Work Location: On the road