Medicare QA Pharmacist

Job Summary

A company is looking for a Quality Assurance (QA) Pharmacist - Medicare.

Key Responsibilities

• Perform monthly audits for coverage determinations and appeals in compliance with CMS regulations
• Create and maintain progress reports and present audit results to leadership
• Collaborate with operational leaders to identify training opportunities and recommend process improvements

Required Qualifications

• Active, unrestricted pharmacist license
• 2+ years of experience in Medicare coverage determination and appeals auditing
• Extensive knowledge of Medicare operational requirements
• Ability to work independently in a remote, high-volume environment
• Experience with CMS program audits is preferred