Pharmacy Claims Auditor - Quality & Compliance Specialist
City of Lincoln
The City of Lincoln is seeking a full-time Claims Auditor in Ridgefield Park, NJ. The ideal candidate will have a solid background in Long-Term Care Pharmacy and will be responsible for preparing audit responses, reviewing claims, and ensuring compliance. This role requires excellent problem-solving skills, MS Office proficiency, and the ability to communicate effectively with diverse stakeholders. Join our team to contribute to quality improvement and customer service excellence. #J-18808-Ljbffr
$32 per hour
FuseGlobal is seeking a Quality and Compliance professional in Edgewater, New Jersey. This role focuses on ensuring adherence to food safety initiatives and specifications via training and development of quality professionals. The ideal candidate will have a strong background...SuggestedHourly pay$20 - $24 per hour
...#claimsauditor, #qualityimprovement, #pharmacy Employee Type Full Time Required Degree... ...High school Phone 908.241.6337 Ext. 4017 CLAIMS AUDITOR We are seeking a Claims Auditor with QI... ...billing errors, discrepancies, and compliance issues. Obtain, validate, and organize...ClaimsFull timeLocal areaMonday to Friday- ...celebrate their potential, and help spark brighter futures. Summary: Seeking a detail-oriented and mission-driven Quality Improvement and Compliance Specialist to support NeuSpark PDS in maintaining adherence to OPWDD regulations, Medicaid standards, and internal policies...SuggestedFor contractorsWork at officeMonday to Friday
$51.8k - $75k
...RSC Insurance Brokerage, Inc. is seeking a detail-oriented Audit Specialist to conduct thorough audits of claims files, ensuring compliance and accuracy. The ideal candidate will have 4–6 years of claims or audit experience, a bachelor's degree preferred, and strong analytical...Claims- ...Job Description Job Description Quality Assurance Compliance Specialist Allendale, NJ Lynkx Staffing LLC specializes in placing talented professionals in the Biotechnology, Pharmaceutical and Medical Devices industries in New Jersey. This position will report into...SuggestedNight shift
- ...Independence Blue Cross (Independence) is seeking a fully remote Certified Pharmacy Technician Auditor to conduct audits on pharmacy claims, ensuring accurate provider payments and identifying potential fraud, waste, or abuse. The role requires an extensive understanding...ClaimsRemote work
- Alltrista Plastics LLC, located in Pennsylvania, seeks a Coordinator, Quality Compliance to ensure quality management practices across production. Responsibilities include managing complaints, overseeing audits, and maintaining supplier quality standards. The ideal candidate...
- A New York-based compliance organization is seeking a Quality Improvement Specialist to support agency-wide performance improvement efforts. This role involves monitoring compliance with regulations, conducting audits, and analyzing data to enhance service delivery for...Full timeMonday to Friday
- A reputable compliance assurance organization in New Jersey is seeking a candidate to ensure compliance through detailed review of records... ...in aligning personal objectives with broader site goals, contributing to the overall quality team efforts. #J-18808-Ljbffr Mindlance
- S:US is seeking a Quality Improvement Associate to enhance and maintain quality standards across the organization. In this role, you will conduct site visits, participate in audits, and develop training for staff on quality improvement processes. Ideal candidates will possess...Flexible hours
- GlaxoSmithKline is seeking a quality professional in Pennsylvania to support product and process compliance activities. The role involves managing change control, investigating deviations, and ensuring quality systems remain inspection-ready. Candidates should have an...
- ...Independence Blue Cross is seeking an Auditor, Payment Integrity to conduct pharmacy claim audits ensuring accurate provider payments while detecting fraud and improving audit processes. This fully remote role requires a Certified Pharmacy Technician with at least...ClaimsWork at officeRemote work
- RPMGlobal in Totowa, New Jersey, is seeking a Training Specialist to support quality and manufacturing initiatives. The role involves developing... ...training programs, assessing training needs, and ensuring compliance with CGMP regulations. Ideal candidates will hold a...
$68k - $96k
...how your ideas and expertise can change a patient’s life. Our Quality teams help shape the development of groundbreaking... ...patients around the world with pioneering technology. The Quality Compliance Specialist will evaluate global complaint information provided, conduct...Work experience placementRemote work$80k - $115k
...City, MI; and Nampa, ID. Procurement Compliance Specialist is a member of the North America Procurement... ...procurement practices, supplier quality, legal compliance, and Corporate Social... ...conversations with quality; coordinate claims preparation and timely recovery....ClaimsWork experience placementWork at officeLocal area$121.79k - $183.65k
Medication Regulatory Compliance Specialist - PharmD required On-Site Allied Health - Pharmacy New York, NY ID: 1160187_RR00118962 Full-Time/Regular NYU Langone Health... ...patient outcomes through a rigorous focus on quality that has resulted in some of the lowest...Full time- Santa Barbara Cottage Hospital is seeking a qualified nurse to enhance clinical effectiveness and ensure readiness for Joint Commission surveys. The role involves overseeing performance improvement activities while promoting patient education and interdisciplinary teamwork...
- Metropolitan Jewish Health System, Inc. is hiring for a quality assurance position in New York City focused on care management documentation and compliance. This role will ensure that care management records meet regulatory standards through development of auditing tools...
- Downtown Boulder Partnership is seeking a Quality Assurance Officer responsible for reviewing clinical treatment and documentation while implementing improvements. This role ensures compliance with industry standards and enhances the quality of care provided by the agency...
- ...SpecialtyRx is a Long-Term Care pharmacy providing pharmaceutical services... ...delivering personalized care and quality pharmacy services. NOTICE: SpecialtyRx... ...insurance information, resolving claim rejections, and maintaining compliance with payer requirements. This role...ClaimsLocal area
$47 - $56 per hour
...Senior Auditor Quality - CCCR Job Locations US-Remote ID 2026-18251 Category Audit - Healthcare... ...for ensuring that the audited claims meet quality standards necessary to generate... ...clients. Quality assurance emphasizes compliance with established procedures, accuracy of...ClaimsFull timeWork at officeImmediate startRemote workFlexible hours$65k - $72k
...Credentialing & Medicaid Specialist – Specialty Pharmacy $65,000–$72,000 (flexible based on experience... ...including licenses, accreditations, and compliance documentation Monitor payer and... ...resolve enrollment issues impacting claims Route and manage provider and...ClaimsContract workRemote workFlexible hours$20 - $24 per hour
...Claims Auditor Location: 2 Bergen Turnpike, Ridgefield Park, NJ, 07660, United States Base Pay: $20.00 - $24.00 / Hour Job Category: Claims Auditor, Quality Improvement, Pharmacy Industry: Long Term Care, Retail, Hospital Employee Type: Full Time Required...ClaimsFull time$97.1k - $114.4k
The Underwriting Quality Auditor ensures the integrity, consistency, and compliance of underwriting practices across all lines of business. This role evaluates underwriting... ...Qualifications Background in quality assurance, claims, compliance, or knowledge of multiple insurance...ClaimsFull timeWork at office- Job Summary The Pharmacy QA Specialist plays a critical role in the pharmacy... ...accuracy, completeness, and quality of pharmacy-related... ...documentation quality Ensure compliance with applicable state, federal... ...process over 200,000 insurance claims annually for leading...ClaimsRemote jobTemporary workWork at officeWork from home
$32 per hour
...20 years) Initial term: 12 months (position expected to run longer) Schedule: M-F 8am - 5pm About This Role Guardian of Quality and Compliance by Design following the quality requirements and deliverables for Food Safety initiatives in raw material specifications (mainly...Hourly pay- Quality Specialist - Cosmetics & OTC Compliance Location: hybrid (preferred) remote (possible for experienced self-starter meeting qualifications) Employment Type: Full-time, long-term Contract/1099 Evermark is a newly formed beauty and personal care company bringing together...Long term contractFull timeContract workRemote work
- ...Anticoagulation Management, Medication Compliance & Safety, CMS Fraud/Waste/Abuse, Part-D quality and safety compliance activities... ...PACE IDT members and dispensing pharmacy to optimize PACE participant... ...Prescription Drug Event claims processing and claims adjudication...ClaimsTemporary workInternshipFlexible hours
$60k - $75k
...Job Description Job Description Compliance Specialist – Affordable Housing Queens, NY | Full-Time | About the Company EqualAccess is... ...preparing properties for agency audits. Think of this role as part quality control, part compliance navigator, and part regulatory...Full timeInterim roleWork at officeLocal area- ...intelligent data management, pharmacy optimization, and value-driven... ...as the operational and compliance lead for Coral’s 340B Infusion... ...program delivery, from internal quality assurance framework design and... ...discrepancies before and after claim submission. Conduct monthly...ClaimsContract workRemote work
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