Pharmacy Auditor

2 weeks ago

Dwarka Delhi Delhi, India BENSUPS Pharmacia Private Limited Full time

The Pharmacy Auditor will be responsible for end-to-end billing for CGHS and ECHS patients, ensuring complete compliance with government panel guidelines. This role involves meticulous audit of pharmacy bills, detection and escalation of billing malpractices, and ongoing stock audits to maintain integrity and transparency in pharmacy operations.

**Key Responsibilities**:
**1. Pharmacy Billing (CGHS/ECHS)**:

- Generate and verify all CGHS/ECHS pharmacy bills as per panel guidelines and rate contracts.
- Ensure correct medicine mapping as per CGHS formulary and prescriptions.
- Prepare final bill summaries for submission to CGHS/ECHS authorities within defined timelines.
- Track rejection reasons and rectify billing errors to minimise deductions.

**2. Audit and Compliance**:

- Conduct daily/weekly audits of pharmacy billing and issue reports on any discrepancies.
- Identify duplicate billing, non-issued medicines, substitutions, or overcharging.
- Validate doctor prescriptions vs actual issuance to detect any mismatch or malpractice.

**3. Escalation and Reporting**:

- Escalate suspected malpractices or policy violations to hospital administration and finance head.
- Maintain a log of all escalations, actions taken, and outcomes for internal compliance records.
- Liaise with external auditors during government audits or inspections.

**4. Stock Management & Audit**:

- Conduct monthly physical stock audits and reconcile with system stock.
- Monitor high-value, short-expiry, and fast-moving drugs separately.
- Ensure all inward and outward entries are updated in the inventory software.
- Work closely with the procurement team to flag discrepancies or expired/near-expiry drugs.

**5. Documentation & Coordination**:

- Maintain clear and organised documentation for each CGHS/ECHS claim.
- Coordinate with pharmacists, doctors, the billing team, and accounts for smooth functioning.
- Prepare MIS reports on pharmacy billing performance, stock variances, and rejection trends.

**Key Performance Indicators (KPIs)**:

- % billing accuracy for CGHS/ECHS patients
- % rejection rate of pharmacy bills
- Time taken for bill preparation and submission
- No. of malpractices/escalations detected and resolved
- Stock variance % during monthly audits
- Timely reporting and closure of flagged discrepancies

**Qualifications**:

- B.Pharm or D.Pharm; MBA (Healthcare/Operations) is a plus
- Minimum 3 years of experience in hospital pharmacy billing, preferably with CGHS/ECHS
- Strong understanding of CGHS/ECHS rules, medicine pricing, and formulary
- Proficient in MS Excel and pharmacy billing/inventory software (e.g., Marg, Mediface, or similar)
- Excellent attention to detail and ethical judgment

Pay: ₹25,000.00 - ₹30,000.00 per month

**Benefits**:

- Paid time off

Schedule:

- Day shift
- Weekend availability

Supplemental Pay:

- Performance bonus

Application Question(s):

- Describe your role and how you ensured compliance with CGHS/ECHS pricing and formulary.
- Explain how you would detect malpractice or discrepancies in pharmacy billing or stock
- What steps would you take if a CGHS bill was rejected or faced deductions?

License/Certification:

- D.Pharm or B.Pharm (required)

Work Location: In person

Application Deadline: 10/05/2025
Expected Start Date: 12/05/2025

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