[Hiring] Claims Auditor @RiteChoice Rx

Role Description

Are you detail-oriented, analytical, and interested in helping pharmacies strengthen compliance and reduce audit risk? Do you enjoy reviewing information, identifying patterns, and helping teams improve their processes? RiteChoice Rx may be the right fit for you.

We are seeking an organized and compliance-focused Claims Auditor to join our Compliance Department. This role will support internal pharmacy claims auditing, help identify billing and documentation discrepancies, and work closely with pharmacy teams and operational leadership to strengthen audit readiness.

The ideal candidate is someone who can review claim details carefully, communicate findings clearly, and support a culture of compliance across the organization. Pharmacy auditing, medical billing auditing, or pharmacy technician experience is strongly preferred.

The Claims Auditor will report directly to the Compliance Manager. This is a full-time position, remote, with occasional travel to the corporate office.

Essential Job Duties

• Perform routine internal audits of pharmacy claims to ensure billing accuracy, proper documentation, and compliance with federal, state, PBM, and company requirements.
• Review submitted and adjudicated claims to confirm that key claim elements are accurate, including patient information, prescriber details, medication, quantity, day supply, DAW codes, origin codes, insurance billing, and supporting documentation.
• Identify, investigate, and document claim discrepancies, billing irregularities, documentation deficiencies, refill timing concerns, override issues, cash billing variances, and other potential audit risks.
• Ensure claims are properly supported by required documentation, including hardcopy notes, signatures, delivery records, claim history, payer communication, rebill notes, reversal activity, and override documentation.
• Monitor pharmacy billing practices to help reduce audit exposure, chargebacks, and compliance concerns.
• Track audit findings and identify patterns or recurring issues that may point to workflow, training, or process gaps.
• Communicate audit results, trends, and potential risks to the Compliance Manager, pharmacy leadership, and operational teams.
• Partner with pharmacy teams and operational leadership to help correct claim issues, strengthen front-end workflows, and improve overall audit readiness.
• Develop reports and summaries that show claim accuracy, audit trends, correction timelines, recurring errors, and opportunities for improvement.
• Support training and education for pharmacy staff on insurance requirements, documentation expectations, billing practices, and audit readiness.
• Participate in cross-training, peer review, and process improvement efforts to support consistency across pharmacy locations.
• Maintain professionalism, confidentiality, and integrity in all audit-related activities.

Qualifications

• Medical billing auditing experience
• Pharmacy auditing or pharmacy technician experience preferred
• Applies Growth Mindset - Actively seeking new ways to grow and be challenged
• Demonstrates a deep understanding of the pharmacy regulations
• Thinks and acts strategically
• Ensures Outcomes - minimizes company exposure to outside auditors and regulators
• Participates actively within a High Performing Teams
• Engages and inspires others
• Communicates to ensure readiness to execute programs

Benefits

• Work for an engaging and growing company
• Health and vision insurance
• Dental insurance
• Paid time off
• 401(k) with employer matching
• Competitive salary
• Performance-based bonus eligibility, if applicable

Schedule

• Full-time position
• Remote work setting
• Occasional travel to the corporate office may be required
• Monday to Friday schedule anticipated