Pharmacy Audit & Credential Coordinator (Remote)

Job description

SUMMARY: The OSPS Credentialing and Audit Coordinator plays a key role in supporting the Client Services team by managing pharmacy credentialing activities, coordinating responses to PBM and third-party audits, and resolving payor-related issues. This role supports compliance, reimbursement optimization, and strategic initiatives across the organization. ESSENTIAL FUNCTIONS: - Support the coordination and timely response to PBM and third-party audits, ensuring all requests are reviewed and addressed within required deadlines - Prepare and organize audit responses and assist with appeal submissions when applicable - Collect, review, and validate audit documentation from pharmacies to ensure accuracy and completeness prior to submission - Assist with PBM-related activities, including MAC appeals, claim rejections, and reimbursement discrepancies - Maintain active pharmacy credentialing with all required entities in compliance with regulatory and contractual requirements - Communicate with PBMs to verify contracted reimbursement rates and initiate appeals as needed - Maintain and audit contract and carrier code data within the third-party reconciliation system to ensure financial accu...