pharmacy aud it Support representativeHCM Nexus

About the Role
We are seeking a Pharmacy Audit Support Representative to join our team. This role is responsible for reviewing and analyzing pharmacy claims to ensure compliance with regulations and company standards. The position involves working closely with pharmacy providers, verifying claims data, identifying discrepancies, and supporting audit processes to maintain the accuracy and integrity of our claims systems.Key ResponsibilitiesReview pharmacy claims against company policies and regulatory guidelines to identify errors or potential fraud.Communicate with pharmacy providers to verify billing details and request claim adjustments when necessary.Document audit support findings, prepare reports, and maintain accurate records of communications.Review prescriptions, dispensing activities, and supporting documents for billing accuracy.Escalate compliance concerns, including cases of suspected fraud, waste, or abuse.Prepare correspondence and coordinate with internal teams to support the provider audit process.Participate in special projects, reporting, and problem resolution activities.QualificationsHigh school diploma (or equivalent) required; Associate degree or college coursework preferred.At least 1 year of experience in a pharmacy setting and 1 year of administrative or customer service experience.Working knowledge of Microsoft Office (Word, Excel) and familiarity with database systems.Pharmacy Technician license or certification is an advantage but not required.Strong knowledge of pharmacy practices, prescription interpretation, and standard medication dosages.Excellent communication skills (verbal and written) with the ability to manage sensitive provider interactions.Highly organized, detail-oriented, and capable of working independently.What We're Looking ForAdaptability and problem-solving skills in fast-paced environments.Strong professionalism, customer focus, and commitment to accuracy.Ability to handle multiple priorities and meet deadlines.Work EnvironmentStandard office hours: Monday to Friday, 8:00am 5:00pm (overtime or weekend work may occasionally be required).This role may involve limited travel depending on business needs.
HCM Nexus

Cebu City, Cebu
Permanent
Full-time