Pharmacy Network Auditor

RxSense

Pharmacy Network Auditor responsible for compliance and audit program growth at RxSense. Managing pharmacy audits and collaborating with external vendors to prevent Fraud Waste Abuse.

Posted 7/7/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesMid-LevelSenior💰 $74,000 - $110,000 per yearWebsite

About the role

Key responsibilities & impact

The Pharmacy Network Auditor is responsible for the maintenance and growth of the Pharmacy Network Audit program and processes at RxSense
Evaluates, reports and monitors all aspects pertaining to Pharmacy Network Auditing services
Serves as a subject matter expert regarding standard monitoring measures, auditing procedures, and best practices
Assesses risks suggested by audit vendor, performs appropriate audit procedures, and collaborates with pharmacy management for efficient issue resolution
Drafts and communicates audit findings to internal stakeholders; provides Quarterly Network Audit Performance Reports to leadership
Screens and summarizes authorized vendor audit results
Reviews results to identify fraudulent, erroneous, or abusive billing activity
Analyzes claims data for potential investigational FWA breaches of network pharmacies
Maintains audit documentation, and prepares statistical data for review and action
Develops and updates Standard Operating Procedures for audit and FWA Programs
Collaborates with key stakeholders to support pharmacy network initiatives.

Requirements

What you’ll need

Previous Pharmacy Audit Experience is required, understanding of the processes and industry related guidelines are mandatory
5+ years of experience in a Retail Pharmacy setting and/or Pharmacy Benefits Management organization
Strong understanding of the pharmacy claims processing ecosystem
Strong understanding of pharmacy relationships and NCPDP data extracts
Proficient knowledge and ability to leverage current reporting tools to identify audit and FWA issues proactively
Strong understanding of Pharmacy Network Standards and how to manage potential FWA issues via claims data
Proficient knowledge of URAC and CMS network requirements in addition to Federal and State level auditing network requirements
Ability to research, analyze and report on audit results and industry trends in FWA
Proven ability to work independently and drive results
Detail-oriented, ability to multitask, proactive thinker
Excellent written and verbal communication skills
Experience with presenting and or training
Proficiency in MS Word and Excel.

Benefits

Comp & perks

RxSense believes in the strength of collaboration, creativity and sense of community a diverse workforce brings.

ATS Keywords

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Hard Skills & Tools

Pharmacy Network AuditingClaims Data AnalysisAudit ProceduresStatistical Data PreparationStandard Operating Procedures Development

Soft Skills

Detail-OrientedProactive ThinkerExcellent Communication SkillsAbility To MultitaskIndependent Work