In this position, you will serve as the final line of defense before healthcare claims go out the door. Your core objective is to perform meticulous audits comparing Delivery Tickets (DTs)—itemized receipts of prescriptions and infusion supplies sent to patients—against pharmacy billed claims to ensure 100% accuracy and prevent front-end errors that cause payment delays.

This is a "heads-down," detail-intensive role requiring strong critical thinking, document auditing across multiple software portals, and a solid grasp of pharmacy benefits.

Key Responsibilities

• Delivery Ticket (DT) Scrubbing: Audit outgoing Delivery Tickets (prescriptions, supplies, and infusion equipment) against pharmacy billed claims in CareTend to verify complete accuracy prior to claim submission.

• Pre-Billing Quality Audits: Review operational data generated by Referral Management, Intake, Insurance Verification, and Copay Assistance departments.

• Prior Authorization & Coverage Review: Verify PDP and Medical Prior Authorizations, insurance verification entries, and copay/billing details.

• Nursing Note & Tracking Prep: Audit nursing software, nurse tracking logs, and associated nursing notes for billing readiness.

• Cross-Departmental Collaboration: Communicate effectively with Referral Management, Billing, Data Entry, and Insurance Verification teams to resolve errors before submission.

• Payer & Formulary Navigating: Maintain a strong working knowledge of payers, reimbursement models, and formularies to assist in accurate product and billing selection.

• General Administrative Support: Maintain organized billing files, data entry records, and compliance documentation while upholding strict HIPAA and regulatory standards.

Qualifications & Requirements

• Experience: Minimum of 2 years in a healthcare, pharmacy, or medical billing/intake environment.

• Pharmacy Benefit Knowledge: Solid understanding of pharmacy benefits, claims review, and insurance verification workflows.

• Core Mindset: Exceptional critical thinking, high attention to detail, and a focus on heads-down auditing across multiple portals and systems simultaneously.

• Certifications (Preferred): Active Texas Pharmacy Technician License or certification via PTCB or NHA is a strong plus.

• Tech-Savvy: Experience with pharmacy/home infusion platforms (e.g., CareTend) and prior authorization portals is highly preferred.

• Soft Skills: Ability to self-manage, shift directions easily, and work independently while maintaining high communication standards with multidisciplinary teams.

Schedule: Applicants must be able to be fully onsite Monday - Friday 8:30 am to 5 pm in Plano, TX

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients