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Remote Pharmacy Auditor Jobs (NOW HIRING)

CERiS

Clinical Review QC Auditor

Fort Worth, TX · On-site +1

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Review medical records to ... Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account ...

Corvel

Clinical Review QC Auditor

Fort Worth, TX · On-site +1

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Review medical records to ... Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account ...

CERiS

Clinical Review QC Auditor

Fort Worth, TX · Remote

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Review medical records to ... Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account ...

Corvel

Clinical Review QC Auditor

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Review medical records to ... Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account ...

CERiS

Clinical Review QC Auditor

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Review medical records to ... Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account ...

CERiS

Clinical Review QC Auditor

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Review medical records to ... Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account ...

AnewHealth

Certified Pharmacy Technician - Start of Care

$18.50 - $22.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is an office (or remote) based, cubicle environment, allowing the Pharmacy Technician to ... Perform claim adjudication and auditing duties such as prior authorizations, billing and ...

AnewHealth

Pharmacy Technician - Engagement (8:00AM - 4:30PM ET)

$18 - $21.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote-based environment, allowing the Pharmacy Technician to provide an exceptional over ... Perform claim adjudication and auditing duties such as prior authorizations, billing and ...

AnewHealth

Pharmacy Technician - Engagement (11:00AM - 7:30PM ET)

$18 - $21.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote-based environment, allowing the Pharmacy Technician to provide an exceptional over ... Perform claim adjudication and auditing duties such as prior authorizations, billing and ...

AnewHealth

Pharmacy Technician - Engagement (12:30PM - 9:00PM ET)

$18.75 - $23/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote-based environment, allowing the Pharmacy Technician to provide an exceptional over ... Perform claim adjudication and auditing duties such as prior authorizations, billing and ...

Scanhealthplan

Senior Accountant - Pharmacy (REMOTE)

$75K - $95K/yr

  • Retirement

  • PTO

The role collaborates closely with internal departments, external vendors, auditors, and regulatory ... Accountant Sr Pharmacy * Work Mode: Mostly Remote * An annual employee bonus program * Robust ...

SCAN Group

$77K - $97K/yr

  • Retirement

  • PTO

The role collaborates closely with internal departments, external vendors, auditors, and regulatory ... Accountant Sr Pharmacy * Work Mode: Mostly Remote * An annual employee bonus program * Robust ...

Humana

Compliance Lead (Pharmacy)

$160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience in auditing and consulting. * Experience working with regulatory agencies, including CMS ... This position is remote; however, candidates residing in and around the Louisville, KY area may ...

Humana

Compliance Lead (Pharmacy)

$160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience in auditing and consulting. * Experience working with regulatory agencies, including CMS ... This position is remote; however, candidates residing in and around the Louisville, KY area may ...

Humana, Inc.

Compliance Lead (Pharmacy)

$160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience in auditing and consulting. * Experience working with regulatory agencies, including CMS ... This position is remote; however, candidates residing in and around the Louisville, KY area may ...

Humana

Compliance Lead (Pharmacy)

$160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience in auditing and consulting. * Experience working with regulatory agencies, including CMS ... This position is remote; however, candidates residing in and around the Louisville, KY area may ...

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Remote Pharmacy Auditor information

See salary details

$30.5K

$72.6K

$117.5K

How much do remote pharmacy auditor jobs pay per year?

As of Aug 17, 2026, the average yearly pay for remote pharmacy auditor in the United States is $72,633.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,000.00 and $98,500.00 per year, depending on experience, location, and employer.

What is a remote pharmacy auditor?

A Remote Pharmacy Auditor is a professional who reviews pharmacy operations, records, and billing practices from a remote location, typically for compliance with healthcare regulations, insurance policies, and internal standards. They analyze prescription claims, identify discrepancies, and ensure pharmacies adhere to proper procedures. The role often involves using specialized software to access and evaluate pharmacy data, communicate findings, and recommend corrective actions. Remote Pharmacy Auditors play a key role in preventing fraud, reducing errors, and improving the quality of pharmacy services.

What are the key skills and qualifications needed to thrive as a remote pharmacy auditor, and why are they important?

To thrive as a Remote Pharmacy Auditor, you need a strong background in pharmacy or healthcare, detailed knowledge of pharmacy billing practices, and typically a relevant degree or pharmacy technician certification. Familiarity with pharmacy management software, auditing tools, and claims management systems is essential. Excellent analytical thinking, attention to detail, and clear written communication are crucial soft skills for identifying discrepancies and collaborating with both internal teams and external partners. These skills ensure accurate audits, regulatory compliance, and the financial integrity of pharmacy operations.

What are some common challenges faced by remote pharmacy auditors, and how can they be addressed?

Remote Pharmacy Auditors often encounter challenges such as navigating various pharmacy management systems, ensuring clear communication with offsite teams, and staying updated with frequently changing compliance regulations. To address these, auditors should become proficient in multiple digital platforms, prioritize regular virtual check-ins with pharmacy staff, and participate in ongoing training to keep up with regulatory updates. Strong organizational skills and a proactive approach to resolving discrepancies are also crucial for success in this remote role.

What is the difference between Remote Pharmacy Auditor vs Remote Pharmacy Technician?

AspectRemote Pharmacy AuditorRemote Pharmacy Technician
CertificationsPharmacy Auditor Certification, State LicensesCertified Pharmacy Technician (CPhT), State Licenses
Work EnvironmentReviewing pharmacy records remotely, compliance auditsAssisting pharmacists, data entry, customer service
Employer & Industry UsageHealthcare, pharmacy compliance companiesRetail pharmacies, hospitals, mail-order pharmacies

Remote Pharmacy Auditors focus on reviewing pharmacy records for compliance and accuracy, often requiring specialized certifications. Remote Pharmacy Technicians assist pharmacists with daily operations and customer interactions, typically needing CPhT certification. While both roles work remotely within the pharmacy industry, their responsibilities and certifications differ significantly.

More about Remote Pharmacy Auditor jobs

What cities are hiring for Remote Pharmacy Auditor jobs?

Cities with the most Remote Pharmacy Auditor job openings:

What are the most commonly searched types of Pharmacy Auditor jobs?

The most popular types of Pharmacy Auditor jobs are:

What states have the most Remote Pharmacy Auditor jobs?

States with the most job openings for Remote Pharmacy Auditor jobs include:

What job categories do people searching Remote Pharmacy Auditor jobs look for?

The top searched job categories for Remote Pharmacy Auditor jobs are:

Remote Pharmacy Auditor jobs near you
Infographic showing various Remote Pharmacy Auditor job openings in the United States as of August 2026, with employment types broken down into 95% Full Time, and 5% Contract. Highlights an 100% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Clinical Review QC Auditor

CERiS

Fort Worth, TX • On-site, Remote

$68K - $104K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 11 days ago

Job description

CERIS in Fort Worth, TX is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
  • Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
  • Check for physician's notes supporting the DRGs assigned
  • Conduct audits to ensure accurate reimbursement and identifying potential savings
  • Review previously conducted audits to ensure accurate coding and identifying potential savings
  • Review all opportunities sent to the customers for complete and correct information
  • Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
  • Understand and comply with all internal and external policies
  • Working knowledge of HIPAA Privacy and Security Rules
  • Assist Quality Control team and medical director with appeals, rebuttals, etc.
  • Notify leadership of any issues or concerns in a timely manner
  • Additional duties as assigned

KNOWLEDGE & SKILLS:
  • Expert knowledge of application of current Official Coding Guidelines and Coding Clinic citations
  • Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments
  • Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines
  • Effective and professional communication skills, both verbal and written
  • Ability to work independently and in a team environment
  • High attention to detail
  • Must possess critical thinking skills
  • Ability to multi-task and assist with team coverage and provide support when needed
  • Ability to build relationships both internally and externally
  • Ability to work in a fast-paced environment
  • Demonstrated proficiency in basic computer skills and typing
  • Proficiency with Microsoft Office
  • Proficient in both MS and APR DRG methodology preferred

EDUCATION & EXPERIENCE:
  • LVN or RN license in the state of employment preferred
  • Experience in the OR, ICU, or ER as an RN highly preferred
  • Required minimum of 2 year of recent DRG Quality Auditing experience in a hospital setting, or health plan. National Coding Certification required through either AHIMA (preferred) or AAPC
  • Extensive hands-on ICD-10 CM / PCS experience required

PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $68,566 - $104,841
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CERIS:
CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
CERIS logo

About CERIS

Sourced by ZipRecruiter

Industry

Health care and social assistance

Company size

51 - 200 Employees

Headquarters location

Fort Worth, TX, US

Year founded

1990

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