2516 Freedom Lane
Stockton, CA 95204
Job Objective To enhance my skills and further my career by filling the position of Pharmacy Auditor in well-established organization.
Summary of Qualifications:
- Remarkable experience in conducting Fraud, Waste, Abuse audits
- Sound knowledge of hospital, drug and long-term care pharmacy operations
- Wide knowledge of pharmacy reference data and healthcare coding
- Good understanding of pharmacy laws and regulations
- Proficiency in Microsoft Word, Excel and Access
- Familiarity with pharmacy claim adjudication standards and procedures
- Immaculate communication skills
- Strong analytical and investigative skills
Pharmacy Auditor, August 2005 – Present
Connolly, Inc, Stockton, CA
- Reviewed pharmacy claims within the medical benefit for potential errors.
- Developed claim edits, and reports of results.
- Coordinated with providers i.e. hospitals, outpatient facilities, pharmacies etc.
- Corroborated audit findings as per payer processing principles.
- Communicated with management on audit findings and assisted with issue resolution.
- Suggest improvements and recommendations to meet client satisfaction.
Pharmacy Auditor, May 2000 – July 2005
Cybercoders, Stockton, CA
- Ensured that providers retained proper records as claimed.
- Communicated with providers and customers to provide excellent service standards.
- Followed audit procedures and identified incoherent claims.
- Verified audit data through communication and interaction.
- Ensured to provide authorized services.
- Assimilated audit data to generate the audit reports.
Bachelor’s Degree in Pharmacy, Graceland University, Independence, MO