Insight Global
Prior Authorization (PA) Audit Pharmacist
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The Prior Authorization (PA) Audit Pharmacist is a fully remote role that serves as the clinical subject matter expert for PA audits, primarily supporting audit preparation, participation, and response. This position requires availability during Pacific Standard Time (PST) hours and deep knowledge of the client’s PA program. The pharmacist collaborates closely with the External Audit team to ensure accurate and timely audit deliverables.
Key Responsibilities
Serve as the clinical SME for all Medicare Part D audits conducted by CMS.
Act as the client-facing pharmacist for PA audit issues and oversight.
Lead and support CMS client PA audits and other regulatory or quality audits.
Collaborate with Appeals, Prior Authorization, and Clinical Guideline teams on audit-related topics.
Coordinate audit evidence collection, validation, and submission.
Monitor audit timelines and elevate risks proactively.
Analyze audit requests and findings to identify trends and improvement opportunities.
Review clinical decision-making and documentation for compliance.
Stay current with CMS audit protocols and regulatory updates.
Participate in post-audit debriefs and contribute to continuous improvement.
Provide excellent customer service and communication to internal and external clients.
Respond promptly to client needs and feedback.
Maintain professionalism in managing sensitive or emotional client situations.
Qualifications
Education: PharmD or equivalent combination of education and experience.
Experience: Minimum 3 years of relevant experience, including at least 1 year as a subject matter expert.
Medicare Part D experience or PBM (Pharmacy Benefit Manager) experience.
Prior experience working with prior authorizations.
Current, unrestricted pharmacist license in at least one U.S. state.
Proficiency in Microsoft Office Suite and relational databases.
Expertise in MedResponse, MedAccess, MedOptimize, or similar PBM PA and claims platforms.
Experience with disease management or drug cost management programs preferred.
Ability to interpret market data and medication dosing.
Compensation: $61.75/hr
Seniority Level Associate
Employment Type Contract
Job Function Other
Industries Hospitals and Health Care
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The Prior Authorization (PA) Audit Pharmacist is a fully remote role that serves as the clinical subject matter expert for PA audits, primarily supporting audit preparation, participation, and response. This position requires availability during Pacific Standard Time (PST) hours and deep knowledge of the client’s PA program. The pharmacist collaborates closely with the External Audit team to ensure accurate and timely audit deliverables.
Key Responsibilities
Serve as the clinical SME for all Medicare Part D audits conducted by CMS.
Act as the client-facing pharmacist for PA audit issues and oversight.
Lead and support CMS client PA audits and other regulatory or quality audits.
Collaborate with Appeals, Prior Authorization, and Clinical Guideline teams on audit-related topics.
Coordinate audit evidence collection, validation, and submission.
Monitor audit timelines and elevate risks proactively.
Analyze audit requests and findings to identify trends and improvement opportunities.
Review clinical decision-making and documentation for compliance.
Stay current with CMS audit protocols and regulatory updates.
Participate in post-audit debriefs and contribute to continuous improvement.
Provide excellent customer service and communication to internal and external clients.
Respond promptly to client needs and feedback.
Maintain professionalism in managing sensitive or emotional client situations.
Qualifications
Education: PharmD or equivalent combination of education and experience.
Experience: Minimum 3 years of relevant experience, including at least 1 year as a subject matter expert.
Medicare Part D experience or PBM (Pharmacy Benefit Manager) experience.
Prior experience working with prior authorizations.
Current, unrestricted pharmacist license in at least one U.S. state.
Proficiency in Microsoft Office Suite and relational databases.
Expertise in MedResponse, MedAccess, MedOptimize, or similar PBM PA and claims platforms.
Experience with disease management or drug cost management programs preferred.
Ability to interpret market data and medication dosing.
Compensation: $61.75/hr
Seniority Level Associate
Employment Type Contract
Job Function Other
Industries Hospitals and Health Care
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