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NOW HIRING: (Remote) PBM Audit & Compliance Specialist

Are You a Pharmacy Audit, Compliance, or Revenue Integrity Expert?

Adecco Healthcare is seeking a highly organized and detail-oriented PBM Audit & Compliance Specialist to support a high-volume specialty pharmacy operation. This is an excellent opportunity for professionals with experience in specialty pharmacy, PBM audits, payer operations, pharmacy compliance, revenue integrity, or prescription validation reviews who thrive in a fast-paced environment and enjoy protecting revenue through audit excellence.

$62/Hour

100% Remote Opportunity

Coverage Assignment: October 7, 2026 – November 20, 2026

Monday – Friday | 8:30 AM – 5:00 PM EST

What You'll Be Doing

Audit Management & Administration

• Receive, review, and manage PBM, payer, and payment integrity audit requests

• Track audits from intake through final resolution

• Monitor deadlines, escalations, and compliance requirements

• Maintain accurate audit documentation and records

Audit Response Development

• Review pharmacy claims, prescription records, shipping documentation, and supporting materials

• Gather and validate documentation required for audit responses

• Prepare and submit audit response packages in accordance with payer requirements

• Ensure timely and accurate audit submissions

Appeals & Revenue Protection

• Research audit findings and recoupment determinations

• Assist with developing audit appeals and dispute documentation

• Support objection letters related to audit scope and methodology

• Identify payer contract provisions, provider manual requirements, and pharmacy audit regulations

Risk Management & Reporting

• Monitor audit trends and recoupment activity

• Track appeal outcomes and recovery opportunities

• Identify operational risks and documentation gaps

• Create reports, dashboards, and recommendations for leadership

Compliance Support

• Maintain knowledge of PBM audit regulations and payer requirements

• Support audit-readiness initiatives and corrective action planning

• Partner with compliance and accreditation teams on process improvements

Required Qualifications

• 3+ years of experience in:

• Specialty Pharmacy

• PBM Audits

• Pharmacy Compliance

• Payer Operations

• Revenue Integrity

• Related Healthcare Operations

• Experience reviewing pharmacy claims, prescription documentation, and payer requirements

• Strong written communication and documentation skills

• Advanced Microsoft Excel, Word, and Outlook skills

• Ability to manage multiple deadlines simultaneously

• Excellent analytical, organizational, and problem-solving abilities

Preferred Qualifications

• Specialty pharmacy experience

• PBM audit or payment integrity review experience

• Prescription validation audit experience

• Experience developing audit appeals and recoupment disputes

• Knowledge of state pharmacy audit laws

• Familiarity with PBM provider manuals

• Understanding of URAC and/or ACHC accreditation standards

• CPhT Certification

Ideal Candidate

Loves digging into documentation and identifying discrepancies

Has a strong understanding of pharmacy claims and payer requirements

Thrives in a deadline-driven environment

Possesses exceptional attention to detail

Can work independently while managing a high-volume workload

Enjoys protecting organizational revenue and reducing audit risk

Apply Today! If you have experience in specialty pharmacy, pharmacy compliance, PBM auditing, revenue integrity, payment integrity reviews, payer operations, or healthcare auditing, we want to hear from you!

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria

Pay Details: $62.00 to $60.00 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act

• Los Angeles City Fair Chance Ordinance

• Los Angeles County Fair Chance Ordinance for Employers

• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.