26 pharmacy compliance auditor jobs found

Job Description Join our team as a Pharmacy Compliance Auditor - 340B Program and play a vital role in ensuring access to affordable medications for underserved communities. In this position, you will help safeguard the integrity of the 340B Drug Pricing Program-a federal initiative that enables healthcare organizations to stretch resources and provide comprehensive care to more patients. As a Pharmacy Compliance Auditor, you'll work closely with pharmacy leadership to conduct audits, monitor compliance, and identify opportunities for improvement. This role offers the chance to develop specialized expertise in 340B operations, gain advanced certifications, and make a meaningful impact on patient care and organizational success. If you are detail-oriented, passionate about compliance, and eager to grow in a critical area of pharmacy operations, we'd love to hear from you! Minimum Job Requirements: Minimum of High School Degree or GED is required Must successfully...

Pharmacy Compliance Auditor – 340B Program Join to apply for the Pharmacy Compliance Auditor – 340B Program role at TriHealth . Job Description Play a vital role in ensuring access to affordable medications for underserved communities. Protect the integrity of the 340B Drug Pricing Program—a federal initiative that enables healthcare organizations to stretch resources and provide comprehensive care. As a Pharmacy Compliance Auditor, you’ll work closely with pharmacy leadership to conduct audits, monitor compliance, and identify opportunities for improvement. This role offers the chance to develop specialized expertise in 340B operations, gain advanced certifications, and make a meaningful impact on patient care and organizational success. Minimum Job Requirements Minimum of High School Degree or GED is required Must successfully complete Apexus 340B University within the first 6 months in the position. Advanced 340B Operations Certificate within the first 12 months....

A healthcare organization in Norwood, OH is seeking a Pharmacy Compliance Auditor for the 340B Program. This mid-senior level position involves conducting audits, monitoring compliance, and providing insights for improvement within the pharmacy operations. The candidate should have a high school diploma, relevant experience in pharmacy practices, and an interest in compliance and pharmacy practice advancement. The role offers competitive wages and the potential for career growth. #J-18808-Ljbffr

A healthcare organization in Cincinnati is seeking a Pharmacy Compliance Auditor for the 340B Program. This role involves ensuring compliance, conducting audits, and collaborating with pharmacy leadership. Candidates must have a high school diploma, 2-3 years of relevant experience, and a strong focus on detail and compliance. The position offers opportunities for professional development with advanced certifications, all while making a meaningful impact in the healthcare sector. Join us to enhance patient access to vital medications and services. #J-18808-Ljbffr

A leading healthcare provider in North Carolina is seeking a Compliance Auditor to ensure compliance with federal and state regulations. Responsibilities include conducting compliance audits, documenting findings, and providing necessary recommendations. The ideal candidate will have a bachelor's degree, relevant experience in auditing, and strong analytical skills. This role offers an opportunity to impact patient care positively. #J-18808-Ljbffr

A leading healthcare institution in Durham is seeking a Compliance Auditor to conduct compliance audits ensuring data integrity and adherence to regulations. The role requires a Bachelor's degree, four years of relevant experience, and proficiency in regulatory compliance. The ideal candidate is knowledgeable in Medicare/Medicaid regulations and possesses strong analytical and communication skills. This hybrid position allows flexibility in work arrangements, aiming to build a collaborative and inclusive community. #J-18808-Ljbffr

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Compliance Auditor 5119 - G1 Occupational Summary Conduct health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations pertaining to but not limited to: federal healthcare program requirements, clinical trials billing, privacy, conflict of interest, and anti-kickback and physician relationships. Exercise independent decisions using analytical and problem solving skills. Provides critical analytical and support with respect to third party payer external audits (i.e. RAC, ADR/TPE, UPIC, etc.). Work Performed Interpretation of applicable federal and state law and regulations to plan audit parameters, determine department's compliance with such regulations and communicate to department...

Select how often (in days) to receive an alert: Work Arrangement: Hybrid (On‑Site and Remote mix) Requisition Number: 263058 Regular or Temporary: Regular Location: Durham, NC, US, 27710 At Duke Health, we’re driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Compliance Auditor 5119 - G1 Occupational Summary Conduct health‑system wide compliance audits to ensure data integrity and compliance with federal and state regulations pertaining to, but not limited to: federal healthcare program requirements, clinical trials billing, privacy, conflict of interest, anti‑kickback and physician relationships. Exercise independent decisions using analytical and problem‑solving skills. Provides critical analytical and support with respect to third‑party payer external audits (i.e. RAC, ADR/TPE, UPIC, etc.). Work Performed...

A healthcare organization in California is seeking a 340B Program Auditor responsible for auditing 340B prescription claims and ensuring compliance with federal regulations. This full-time role includes verifying patient eligibility, conducting audits, and maintaining compliance documentation. Ideal candidates should have experience in healthcare auditing and relevant certifications. Competitive salary is offered along with a focus on a supportive work environment. #J-18808-Ljbffr

POSITION TITLE: Compliance Auditor REPORTS TO: Director of Compliance CLASSIFICATION: Non-Exempt POSITION SUMMARY: The Compliance Auditor is responsible for developing and executing audit plans based on research and regulatory guidelines and conducting internal and external audits of departments and their policies. They review programs, records, and systems to ensure adherence to regulations and to support an effective compliance program that prevents illegal, unethical, or improper conduct at the health center. Additionally, they compile and present audit findings to department leadership, assist in implementing procedural changes to resolve compliance issues, and may be reassigned duties as needed for accommodation or staffing reasons. ESSENTIAL FUNCTIONS: The following information is considered the definition of essential functions, but does not restrict the tasks that may be assigned. The Compliance Auditor may be reassigned duties and responsibilities...

If you have a passion for compliance auditing and a drive for operational excellence, join our growing Quality team as a Compliance Auditor and take your career to the next level at Labcorp. This is an Onsite position at 8211 Scicor Drive, Indianapolis, IN. Imagine being involved in innovation and projects that change the course of our industry daily! At Labcorp, one of the world's largest and most comprehensive pharmaceutical solutions service companies, you will have an opportunity to build an exciting career while you make a direct impact on the lives of millions. Job Summary: We are seeking an experienced member to join our Quality Assurance team. The Compliance Auditor plays a pivotal role in ensuring that clinical research laboratory testing operations comply with global regulatory standards and industry-recognized best practices, including GCP/GLP, ISO 15189, and ISO 13485. This position leads the internal audit program execution, drives process improvements,...

Job Description The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines...

Job Description This role will ensure HR operations comply with internal policies, employment laws, and regulatory standards, including Sarbanes-Oxley (SOX) and CEO Certification. This role involves conducting audits, evaluating internal controls, and using advanced Excel skills to analyze data, identify trends, and support compliance reporting. The ideal candidate will lead HR audit engagements across financial, operational, and compliance areas, providing strategic insights to enhance organizational performance and risk management. Additionally, this role focuses on supporting SOX compliance within the Human Resources function of our energy utility organization. Responsibilities Core Responsibilities Conduct audits of HR processes, records, and systems to ensure compliance with internal policies, employment laws, and regulatory standards, including Sarbanes-Oxley (SOX); and co-lead the CEO Certification process to support organization-wide compliance initiatives....

Telecommuting Coding Auditor This position is national remote. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. This position is full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm EST. It may be necessary to attend later meetings according to physician's schedule. We offer 12 weeks of...

Job Summary We are seeking an experienced member to join our Quality Assurance team. The Compliance Auditor plays a pivotal role in ensuring that clinical research laboratory testing operations comply with global regulatory standards and industry-recognized best practices, including GCP/GLP, ISO 15189, and ISO 13485. This position leads the internal audit program execution, drives process improvements, collaborates with management to implement audit strategies, mentors junior auditors, and collaborates with cross‑functional teams to uphold quality and regulatory integrity across clinical laboratory testing and operational environments. The ideal candidate will possess strong leadership skills, a keen eye for detail, and the ability to oversee complex audit functions in a fast‑paced environment with minimal direction. This role requires proactive, timely and responsive engagement with stakeholders, ensuring compliance with industry regulations and internal standards while...

Job Description Job Description Education and/or Experience :   Must have these requirements under the umbrella of the HCC industry: Requires knowledge in HCC Coding documentation guidelines. Requires technical expertise in ICD-9-CM or ICD-10-CM. Strong skills in medical record audit and review. Regulatory requirements for coded data. Medical record documentation requirements. Understanding of healthcare data systems. Proficiency in MS Outlook and Word. Strong proficiency with Excel--must have ability to prepare spreadsheets. Excellent written and verbal communication skills. Certification is a plus with HCC. AHA coding clinic is a plus. Certification required in CPC and/or CCS, and CRC is a plus. Hybrid Schedule Requirements Part A Monday - Wednesday onsite / Thursday - Friday Remote Part B Wednesday - Friday Onsite / Monday - Tuesday Remote   We are looking for HCC Risk Adjustment Auditors/Coders to join our team!   Position...

A global leader in life sciences is seeking a professional in Tampa, Florida, to support quality assurance processes. This role involves document reviews, conducting audits, and ensuring compliance with established standards. The ideal candidate has a Bachelor's degree in a science field and relevant experience in pharmaceutical cGMP. You will work collaboratively on various projects, contributing to the overall success of the company's operations. #J-18808-Ljbffr

Job Posting Performs detailed work involved in the analysis and coding of health information for hospital facility services. Schedule: Monday-Friday. Flexible 8-hour shift between the hours of 6a-6p. Major Responsibilities & Duties: Responsible for thorough and accurate coding of diseases and procedures of each inpatient/hospital record through the use of ICD-10-CM and ICD-10-PCS coding manual and 3M encoder to ensure correct assignment of the Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG.) Responsible for verification of the patient's discharge disposition and to ensure the appropriate present on admission, (POA) indicators are assigned to each code. The assigned codes must support the reason for the visit that is documented by the provider in order to support the care provided. Responsible to assist with writing appeals or resolving coding & reimbursement issues with Pt Financial Services staff and...

Medical Coder Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. As a Medical Coder, you will be responsible for procedure and diagnostic coding of professional charges. Works closely with clinical department physicians and staff to ensure accurate and compliant coding and maximization of revenue through initial coding. Schedule (38.75 hours): Following training, hours will be Monday-Friday (either 4 x 9.7-hour workdays or 5 x 7.75-hour workdays)...

Overview Join to apply for the Inpatient Hospital Coder role at Boys Town National Research Hospital . Performs detailed work involved in the analysis and coding of health information for hospital facility services. Schedule: Monday-Friday. Flexible 8-hour shift between the hours of 6a-6p. Major Responsibilities & Duties Responsible for thorough and accurate coding of diseases and procedures of each inpatient/hospital record through the use of ICD-10-CM and ICD-10-PCS coding manual and 3M encoder to ensure correct assignment of the Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG). Responsible for verification of the patient's discharge disposition and to ensure the appropriate present on admission, (POA) indicators are assigned to each code. The assigned codes must support the reason for the visit that is documented by the provider in order to support the care provided. Assist with writing appeals or resolving...

Business: Boys Town National Research Hospital *$3,000 Hiring Bonus! *Must have Inpatient Coding Experience SCHEDULE: Monday-Friday. Flexible 8-hour shift between the hours of 6a-6p. MAJOR RESPONSIBILITIES & DUTIES Responsible for thorough and accurate coding of diseases and procedures of each inpatient/hospital record using ICD‑10‑CM, ICD‑10‑PCS, 3M encoder and ensuring correct assignment of the Medicare Severity‑Diagnosis Related Group (MS‑DRG) or All Patient Refined Diagnosis Related Group (APR‑DRG). Verify the patient's discharge disposition and ensure the appropriate present‑on‑admission (POA) indicators are assigned to each code, supporting the reason for the visit that is documented by the provider. Assist with writing appeals or resolving coding & reimbursement issues with Patient Financial Services staff and third‑party payers for DRG issues and denials, supporting the assigned DRG and addressing clinical documentation to validate the assigned codes....

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each internal and external customer Represents the Company in a professional manner, following all...

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. This position is full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm EST. It may be necessary to attend later meetings according to physician's...

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...