102 pharmacy compliance auditor jobs found

Onco360 Oncology Pharmacy is seeking a Compliance Auditor to join our growing compliance team. The role conducts routine and random audits across Onco360/CareMed/ConnectMed360 locations to ensure adherence to state and federal regulations governing pharmacy operations. You will develop reports and provide updates to the Vice President, Specialty Pharmacy Compliance, while supporting operational teams with regulatory guidance and issue resolution. #J-18808-Ljbffr

Onco360 Oncology Pharmacy is seeking a Compliance Auditor to join our growing team. This remote role involves on-site and virtual audits across the country, with up to 25% travel. The Compliance Auditor will support the compliance team and report to the Vice President, Specialty Pharmacy Compliance. Qualifications include a Certified Pharmacy Technician registration and 2+ years in pharmaceutical regulatory auditing, with a Bachelor’s degree and CHC preferred. #J-18808-Ljbffr

Clever Care Health Plan in Southern California is seeking a Pharmacy Part D Oversight Auditor to lead independent auditing of Part D clinical compliance, MTM elements, and delegated PBM controls, ensuring timely, accurate, audit-ready documentation. You will coordinate with UM/Part C on benefit coordination, prepare dashboards, and deliver Board-level reporting while adhering to CMS requirements. Requires PharmD or RPh preferred, BS in Pharmacy, and 3–5+ years of Part D auditing. #J-18808-Ljbffr

Bon Secours is seeking a 340B Auditor to monitor compliance with HRSA 340B guidelines across assigned locations. You will perform daily, weekly, monthly and quarterly audits, document results, and support external audits. Responsibilities include reviewing patient eligibility, monitoring 340B purchasing, and data uploads to 340B software systems. Strong Excel and EMR skills preferred. Minimum 1–2 years in pharmacy 340B or hospital/healthcare auditing with excellent communication. #J-18808-Ljbffr

Outpatient Coding Compliance Auditor 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. The Outpatient Coding Compliance Auditor performs audits of outpatient facility (OPPS) coding to ensure accurate assignment of ICD-10-CM diagnoses, CPT/HCPCS codes, modifiers, and facility E/M levels (ACEP or client-specific). This role reviews coding for alignment with medical record documentation and established guidelines, ensuring compliance with applicable laws,...

Join Our Team at Avita Health System – Crestline Avita Health System is proud to serve the communities of Crawford and Richland counties through three hospitals and numerous clinic locations. Over the past few years, we've tripled in size, now employing over 2,300 team members and more than 200 physicians and advanced practitioners. Our mission is to deliver high-quality, compassionate care to the people who depend on us. We're currently seeking a dedicated Certified Coder & Auditor to join our Patient Financial Services Department at our Crestline location. Position Overview Takes a guiding role in the orientation and ongoing education of professional coding team, physicians, and advanced practice providers (APPs) involved in the coding and documentation process. Ensures the accuracy of information in these processes is maintained by conducting audits and analyzing chart documentation and, if accuracy is not at the expected level, reeducates and trains providers and...

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Role Overview The Compliance Auditor II conducts comprehensive audits and reviews across the Plan, including assigned areas and Plan delegates, to ensure adherence to Federal, State, and contractual regulatory requirements. Identifies and assesses risks impacting overall compliance, drafts detailed audit findings and actionable recommendations, and evaluates operations, policies, and processes throughout the Plan. Conducts evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues. Issues corrective action plans and reviews for acceptance to ensure that all compliance issues are appropriately addressed. Performs validation audits to determine if actions have been taken to mitigate identified risks and conducts routine monitoring...

JOB DESCRIPTION SUMMARYPosition reports to the Supervisor Benefit Distribution & Installation and performs in-depth pharmacy and medical plan coding of new and existing business accounts. This position will ensure that all new and existing health (medical/dental/pharmacy) insurance plans underwritten by Western Growers Assurance Trust (WGAT) and those of Pinnacle Claims Management, Inc. (PCMI) are in compliance with the respective employers’ summary plan descriptions.DUTIES AND RESPONSIBILITIESPlan CodingPlan code new business and plan changes.Verify new and existing plans loaded on the company’s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.Respond to work orders received from examiners to investigate plan issues and irregularities.Evaluate testing requests for all new plans prior to loading them into the production system.AdministrativeKeep a detailed log of open and completed...

Medical University of South Carolina seeks a Pharmacist Auditor to promote and enforce pharmacy regulations across MUSC and its entities. The role reports to the System Pharmacy Manager for Regulatory Compliance and leads area audits while collaborating with nursing, clinic, and pharmacy leadership to ensure ongoing compliance. Ideal candidates hold a PharmD with residency training and at least 5 years in inpatient/outpatient pharmacy; SC licensure and BLS are preferred. #J-18808-Ljbffr

Compliance Auditor needed! Join our growing organization! Onco360 has an immediate need for a Compliance Auditor. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting Salary at $60,000 and up, depending on experience Summary The Compliance Auditor will assist the Onco360/CareMed/ConnectMed360 Compliance Team through the completion of routine and random pharmacy compliance audits at Onco360/CareMed/ConnectMed360 pharmacy locations to ensure all pharmacy activities and operations are executed in compliance with state and/or federal regulations and laws governing pharmacy operations. This individual provides support to Onco360/CareMed/ConnectMed360 pharmacy operations teams in answering compliance and regulatory questions based around their needs. The Compliance Auditor shall develop and provide regular reports and updates regarding compliance matters to the...

Aditi Consulting is seeking a compliance-focused professional to help assure adherence to SOPs, cGMP, and CFR guidance in the manufacturing of solid oral dosage pharmaceuticals. The role emphasizes accuracy, documentation integrity, and cross-functional collaboration. Responsibilities include reviewing SOP revisions, conducting real-time batch record audits, performing environmental monitoring, and supporting CAPA-driven site improvements. #J-18808-Ljbffr

Medical Coding Professional 2The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and deficiencies.The...

Become a part of our caring community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will...

Medical Coding Professional 2Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market.Responsibilities:Deliver coding and documentation education to providers and clinic staff within IPA clinics.Be a consultative resource and ongoing support for providers in assigned clinics.Conduct documentation audits to identify gaps, trends, and opportunities for improvement.Perform quarterly chart reviews to support coding accuracy and...

IPA Consultative Coding ProfessionalBecome a part of our caring community and help us put health first. The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with...

Medical Coding Professional 2Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market.ResponsibilitiesDeliver coding and documentation education to providers and clinic staff within IPA clinics.Be a consultative resource and ongoing support for providers in assigned clinics.Conduct documentation audits to identify gaps, trends, and opportunities for improvement.Perform quarterly chart reviews to support coding accuracy and...

Associate Director, Medical Information and ReviewDeciphera, a member of Ono Pharmaceutical Co., Ltd., is a biopharmaceutical company focused on discovering, developing, and commercializing important new medicines and providing hope to people living with cancer, neurologic and autoimmune disease. Deciphera is leveraging its proprietary switch-control kinase inhibitor platform and deep expertise in kinase biology to develop a broad portfolio of innovative medicines. In addition to advancing multiple product candidates from Deciphera's platform in clinical studies, QINLOCK® (ripretinib) is Deciphera's switch-control kinase inhibitor approved in many countries including the European Union and the United States for the treatment of adult patients with advanced gastrointestinal stromal tumor (GIST) who have received prior treatment with 3 or more kinase inhibitors, including imatinib. ROMVIMZA® (vimseltinib) is a kinase inhibitor approved in the United States for adult patients with...

Become a part of our caring community Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market. Responsibilities: You will deliver coding and documentation education to providers and clinic staff within IPA clinics. You will be a consultative resource and ongoing support for providers in assigned clinics. You will conduct documentation audits to identify gaps, trends, and opportunities for improvement. You will...

RCM / Medical Billing SpecialistAlbany, New York, United States; Albuquerque, New Mexico, United States; Scottsdale, Arizona, United StatesWorkit Health is an industry-leading provider of on-demand, evidence-based telemedicine care. Our programs are based in harm reduction, and bring together licensed clinicians who really listen, FDA-approved medication, online recovery groups and community, interactive therapeutic courses, and care for co-existing conditions. Workit Health's patient-centered telemedicine model is improving clinical outcomes and eliminating barriers to treatment, making long-term recovery accessible to individuals who need it, without disrupting their daily lives.We're excited to expand our team as our impact and coverage areas continue to grow. Our team members are dedicated and passionate about our mission of making exceptional, judgment-free care for addiction more accessible.We believe everyone deserves respectful, effective treatment for substance use...

Medical Device In The Quality DepartmentJoin the healthcare information technology team that's turning drug and medical device data into knowledge used by thousands of hospitals; the majority of U.S. health plans, retail pharmacies, and pharmacy benefit managers; and millions of healthcare decision makers throughout the world. Partnering with our information system developer and healthcare institution customers, you'll help evolve leading-edge thinking into reality and make a measurable difference in improving human health.We're looking for people who are: Intelligent. Productive. Committed. Willing and able to go above and beyond. Passionate about making a difference. Innovative. Energized. And want to play an essential role in a successful company's continued growth.Are you ready for this exciting challenge?First Databank (FDB) is currently seeking a Medical Device in the Quality department. This position is responsible for researching data published from the FDA, device...

Medical Device In Quality DepartmentIn Some Jobs You Take Orders. In This One, You Write History.Join the healthcare information technology team that's turning drug and medical device data into knowledge used by thousands of hospitals; the majority of U.S. health plans, retail pharmacies, and pharmacy benefit managers; and millions of healthcare decision makers throughout the world. Partnering with our information system developer and healthcare institution customers, you'll help evolve leading-edge thinking into reality and make a measurable difference in improving human health.We're looking for people who are: Intelligent. Productive. Committed. Willing and able to go above and beyond. Passionate about making a difference. Innovative. Energized. And want to play an essential role in a successful company's continued growth.Are you ready for this exciting challenge?First Databank (FDB) is currently seeking a Medical Device in the Quality department. This position is responsible for...

Join Our Caring CommunityHumana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market.ResponsibilitiesDeliver coding and documentation education to providers and clinic staff within IPA clinics.Be a consultative resource and ongoing support for providers in assigned clinics.Conduct documentation audits to identify gaps, trends, and opportunities for improvement.Perform quarterly chart reviews to support coding accuracy and...

Medical Coding SpecialistCharlotte, North Carolina, United States; Denver, Colorado, United States; New York, New York, United StatesAbout Judi HealthJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, andJudi®, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.Location: Hybrid (Local to Charlotte, NC; Denver, CO; or New York, NY area)Position OverviewWe are...

Medical Coding Professional 2Humana's Primary Care Organization is a leading senior-focused, value-based care provider with 400+ centers across 15 states under the CenterWell and Conviva brands. As an IPA Consultative Coder, you will collaborate with a multidisciplinary team to support the delivery of high-quality, cost-effective care in the communities we serve. In this role, you will work closely with providers and clinic teams to enhance documentation accuracy, identify opportunities for improvement, and reinforce coding and documentation best practices. This is a hybrid position that requires occasional travel within the assigned market.ResponsibilitiesDeliver coding and documentation education to providers and clinic staff within IPA clinics.Be a consultative resource and ongoing support for providers in assigned clinics.Conduct documentation audits to identify gaps, trends, and opportunities for improvement.Perform quarterly chart reviews to support coding accuracy and...