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Pharmacy Claims Auditor - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Scottsdale, Arizona |
About this job
Job Category: Audit
Clinical Licensure Required : N/A
Job Type: Full Time Position Summary:
This is an exciting opportunity to join the pharmacy auditor team at CVS/caremark. We are seeking candidates with pharmacy background to join our team of Medicare auditors in Scottsdale, AZ. Candidates will review pharmacy submitted Medicare claims, make independent decisions, and call network pharmacies to communicate business objectives. Candidates must be highly motivated, possess strong communication skills, effective time management skills, and be very detail-oriented. Candidate will become an expert on the Medicare Audit Programs and will own one or more of those audit program processes on an ongoing basis. Daily tasks may include:
-telephone outreaches to network pharmacies to verify claim information
-transmission of audit requests to pharmacies
-review of hard copy prescriptions to verify compliance with CMS requirements and CVS/caremark contractual requirements
-review of incoming documentation from pharmacies and inputting information into internal CVS/caremark audit systems
-Corresponding with network pharmacies to answer questions regarding Medicare Audit Programs
-Monitor assigned audit processes and report status on a regular basis
Candidate will work closely with internal and external partners to conduct audits. These audit processes help keep CVS/caremark plans in compliance with CMS requirements and maintain positive STAR ratings. Required Qualifications:
-Experience in the pharmacy, PBM, or pharmaceutical industry -Excellent communication skills. -Excellent teamwork and collaboration abilities, self-driven attitude. Preferred Qualifications:
-2-5 years retail pharmacy experience or PBM experience -Knowledge of pharmacy claims processing -Knowledge of PBM industry -Bachelor's degree preferred -CPhT Pharmacy Technician Certification Board (PTCB) license preferred Education:
-High School diploma or equivalent required -Bachelors Degree preferred but not required -CPhT Pharmacy Technician Certification Board (PTCB) license preferred. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. CVS Caremark is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, color, gender, national origin, ancestry, religion, physical or mental disability, age, veteran status, sexual orientation, gender identity or expression, marital status, pregnancy, citizenship, or any other factor protected by anti-discrimination laws. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking
AA EEO CVS Caremark
Clinical Licensure Required : N/A
Job Type: Full Time Position Summary:
This is an exciting opportunity to join the pharmacy auditor team at CVS/caremark. We are seeking candidates with pharmacy background to join our team of Medicare auditors in Scottsdale, AZ. Candidates will review pharmacy submitted Medicare claims, make independent decisions, and call network pharmacies to communicate business objectives. Candidates must be highly motivated, possess strong communication skills, effective time management skills, and be very detail-oriented. Candidate will become an expert on the Medicare Audit Programs and will own one or more of those audit program processes on an ongoing basis. Daily tasks may include:
-telephone outreaches to network pharmacies to verify claim information
-transmission of audit requests to pharmacies
-review of hard copy prescriptions to verify compliance with CMS requirements and CVS/caremark contractual requirements
-review of incoming documentation from pharmacies and inputting information into internal CVS/caremark audit systems
-Corresponding with network pharmacies to answer questions regarding Medicare Audit Programs
-Monitor assigned audit processes and report status on a regular basis
Candidate will work closely with internal and external partners to conduct audits. These audit processes help keep CVS/caremark plans in compliance with CMS requirements and maintain positive STAR ratings. Required Qualifications:
-Experience in the pharmacy, PBM, or pharmaceutical industry -Excellent communication skills. -Excellent teamwork and collaboration abilities, self-driven attitude. Preferred Qualifications:
-2-5 years retail pharmacy experience or PBM experience -Knowledge of pharmacy claims processing -Knowledge of PBM industry -Bachelor's degree preferred -CPhT Pharmacy Technician Certification Board (PTCB) license preferred Education:
-High School diploma or equivalent required -Bachelors Degree preferred but not required -CPhT Pharmacy Technician Certification Board (PTCB) license preferred. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. CVS Caremark is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, color, gender, national origin, ancestry, religion, physical or mental disability, age, veteran status, sexual orientation, gender identity or expression, marital status, pregnancy, citizenship, or any other factor protected by anti-discrimination laws. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking
AA EEO CVS Caremark
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