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Pharmacy Audit Investigator Jobs

Chief Compliance/Audit Investigator
By State of Nevada At Boulder City, NV, United States
Describe your experience, including number of years, in the supervision of the following: 1) compliance investigators, 2) investigative staff.
Describe your experience providing testimony in administrative hearings, courtrooms, or similar environments.
Do you have a Master's degree (or higher) in criminal justice, police science, business administration, public administration, law or psychology?
Chief Compliance/Audit Investigator
By State of Nevada At Henderson, NV, United States
Describe your experience, including number of years, in the supervision of the following: 1) compliance investigators, 2) investigative staff.
Describe your experience providing testimony in administrative hearings, courtrooms, or similar environments.
Do you have a Master's degree (or higher) in criminal justice, police science, business administration, public administration, law or psychology?
Chief Compliance/Audit Investigator
By State of Nevada At Las Vegas, NV, United States
Describe your experience, including number of years, in the supervision of the following: 1) compliance investigators, 2) investigative staff.
Describe your experience providing testimony in administrative hearings, courtrooms, or similar environments.
Do you have a Master's degree (or higher) in criminal justice, police science, business administration, public administration, law or psychology?
Chief Compliance/Audit Investigator
By State of Nevada At Jean, NV, United States
Describe your experience, including number of years, in the supervision of the following: 1) compliance investigators, 2) investigative staff.
Describe your experience providing testimony in administrative hearings, courtrooms, or similar environments.
Do you have a Master's degree (or higher) in criminal justice, police science, business administration, public administration, law or psychology?
Compliance/Audit Investigator 2 Jobs
By State of Nevada At Boulder City, NV, United States

Announcement Number: 42898 Open to all qualified persons. Posted 07/10/2023 Close Date: 07/24/2023 Recruiter: PAULA MILES Phone: (702)486-7957 Email: [email protected] Applications accepted ...

Principal Investigator (Pharmacy) - Remote
By UnitedHealth Group At , Iselin, 08830, Nj $67,800 - $133,100 a year
Demonstrated advanced level of knowledge in state or federal regulatory FWA requirements or 5+ years of experience
Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
Demonstrated advanced level of knowledge in health care fraud, waste and abuse (FWA) or 5+ years of experience
Demonstrated advanced level of knowledge analyzing data to identify fraud, waste and abuse trends or 5+ years of experience
Participate in legal proceedings, arbitration, and depositions at the direction of management
Demonstrated intermediate level of knowledge in health care policies, procedures, and documentation standards or 5+ years of experience
Pharmacy Fraud Investigator-Express Scripts-Remote
By The Cigna Group At United States
Develop these cases in compliance with any applicable policies, procedures, or regulatory requirements.
Experience with Microsoft products strongly preferred (Excel, Access, Word)
Strong communication skills, both written and oral, are required
Minimum 3 years' experience in health insurance investigation and or pharmacy/audit strongly preferred
Analyze and evaluate potential fraud and abuse situations using corroboratory information obtained by correspondence with members, physicians, and pharmacies.
Identify and investigate cases of suspected fraud and abuse for assigned clients.

Are you looking for a challenging and rewarding career in the healthcare industry? Join our team as a Pharmacy Audit Investigator and help us protect the public from fraudulent and illegal activities in the pharmacy industry!

What is Pharmacy Audit Investigator Skills Required?

• Knowledge of pharmacy regulations and laws
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to analyze and interpret data
• Attention to detail
• Problem-solving skills
• Computer proficiency

What is Pharmacy Audit Investigator Qualifications?

• Bachelor’s degree in pharmacy, healthcare administration, or a related field
• Previous experience in pharmacy auditing or compliance
• Certification in pharmacy auditing or compliance
• Knowledge of pharmacy regulations and laws

What is Pharmacy Audit Investigator Knowledge?

• Knowledge of pharmacy regulations and laws
• Knowledge of healthcare reimbursement systems
• Knowledge of medical coding and billing
• Knowledge of medical terminology
• Knowledge of healthcare compliance

What is Pharmacy Audit Investigator Experience?

• Previous experience in pharmacy auditing or compliance
• Experience in healthcare reimbursement systems
• Experience in medical coding and billing
• Experience in medical terminology
• Experience in healthcare compliance

What is Pharmacy Audit Investigator Responsibilities?

• Conducting audits of pharmacy records to ensure compliance with regulations and laws
• Investigating potential violations of pharmacy regulations and laws
• Analyzing and interpreting data from pharmacy records
• Identifying areas of non-compliance and recommending corrective action
• Preparing reports and presentations on audit findings
• Working with