Auditing Clerk

• Review a targeted group of recently paid pharmacy claims to assess accuracy, completeness, and adherence to audit guidelines
• Examine prescription-related records such as original scripts, electronic orders, transfer documentation, delivery confirmation, signature logs, and compounding support files
• Analyze claim activity for unusual prescribing trends, referral relationships, override usage, ingredient cost discrepancies, geographic prescribing patterns, and payment concerns
• Verify that required prescription elements are present, including patient identifiers, issue dates, prescriber information, medication details, quantities, refill authorization, and directions for use
• Confirm that controlled substance documentation meets applicable requirements, including address details and prescriber DEA information when required by law
• Compare submitted records against state and federal documentation standards to identify exceptions, invalid records, or potential compliance gaps
• Document audit findings clearly and escalate questionable billing practices, record inconsistencies, or potential health care fraud indicators for further review
• Maintain organized audit files and prepare concise summaries of findings to support internal review and follow-up actions

• At least 2 years of experience in auditing, claims review, or a related records compliance function
• Strong attention to detail with the ability to evaluate documentation against regulatory and procedural requirements
• Familiarity with prescription record standards, billing review processes, and pharmacy or health care claim documentation
• Ability to recognize irregularities involving tax audits, reimbursement review, or potential health care fraud concerns
• Clear written communication skills for preparing accurate audit notes, findings, and supporting documentation
• Proficiency in handling confidential information with sound judgment and professionalism
• Experience working independently in a remote or desk-audit environment is preferred

Experience working independently in a remote or desk-audit environment

• Medical, vision, dental, and life and disability insurance
• 401(k) plan