Manager, Client Audit

CVS Health

12d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary: CVS Health is currently looking for a dynamic individual to join our Client Audit team in a Manager role. This is a client-facing auditor position that is responsible for coordinating, managing, tracking, reviewing, researching, and assisting with multiple complex health plan sponsor audit activities initiated by CMS. In this position, the Manager will work closely with health plan sponsor clients, various Government auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business. This position requires one to be able to manage multiple audits at the same time with competing priorities accompanied with short turnaround times. The Manager will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, pricing, prior authorizations, and beneficiary accumulation amount tracking in order to review and respond to all audit questions in a timely manner. Skills must include abilities to analytically identify and research claim specific questions and formulate the audit response work. As a Manager of Client Audit, you will be responsible for the following:

Requirements

• Understanding of pharmacy claim adjudication.
• Ability to actively seek new ways to grow and be challenged.
• Critical thinking which translates into strategic actions.
• Excellent verbal and written communications skills.
• Strong project management skills that include the ability to adjust and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion.
• Ability to interact effectively with the government, auditors, and clients in high pressure scenarios.
• High tolerance for flexibility, adaptability, and stress to address the ever-changing dynamics associated with government-initiated audits.
• Strong ability to maintain attention to detail and organizational skills.
• Minimum 5 years of prior relevant experience in audit, project management, or financial manager role.

Nice To Haves

• Previous internal/external audit experience.
• 3 years experience with Pharmacy Claims
• Proficiency in Excel, Teradata, Python, SQL, Word, etc.
• Prior Pharmacy Benefit Management experience is also desired

Responsibilities

• Work directly with the government auditors, plan sponsor clients, and all the internal business areas involved in the audit.
• Manage the assigned audit workload successfully as there is no margin for error with government audits that come in ad hoc and cyclical waves across many clients simultaneously.
• Properly identify, triage, and coordinate multiple audit requests with varied timelines that impact internal business owners.
• Have a working knowledge base of Medicare Part D and the accompanying rules and regulations to address and facilitate the handling of auditor questions.
• Query, analyze, and generate audit response feedback on large audit testing datasets.
• Work independently with limited direction from the Sr. Manager
• Coordinate, manage, and track multiple audits from start to closure.
• Triage, research, and resolve all questions from our clients and the auditors.
• Work through and resolve any alleged audit issues; working strategically and achieving results through coordination within Client Audit and internal business owners.
• Communicate directly with external parties acting on behalf of CVS Health.
• Raise appropriate at-risk items to the Sr. Manager timely.
• Document and retain audit correspondences with internal partners, clients, and auditors.
• Track all audit progress to ensure that all deliverables are provided by the respective client and auditor due dates.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees