Pharmacy Claims Auditor CPhT

Conduent

3h • $57,000 • Hybrid

About The Position

Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor, you will examine a wide variety of pharmacy records against our client’s pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct "on-site" pharmacy audits.

Requirements

• Have National CPhT Certification through the Pharmacy Technician Certification Board (PTCB). Or be able to obtain one within the first few months.
• Have extensive “retail” pharmacy experience.
• Be living in commutable distance to the assigned territory (Philadelphia, PA)
• Have valid driver's license and have a reliable car to visit pharmacies for audits in the local geography.
• Be able to travel overnight/flight 1 week/month (25%).
• Be proficient with Windows and Microsoft Office.
• Be able to stand for long periods of time (Up to 8 hours).
• Be able to lift heavy boxes (about 20 lbs.) containing prescription records. (Most records are electronic.)

Responsibilities

• Examining and interpreting pharmacy records against submitted claim data for potential discrepancies.
• Utilizing specific client instructions, federal and state regulations, and standards of practice to properly access pharmacy documentation.
• Researching board of pharmacy regulations, and state/federal laws as they relate to prescription requirements and pharmacy practices.
• Responding to pharmacy calls regarding audit results and dealing with clients periodically to report audit results.
• Conducting Onsite and Desktop and Credentialing Audits in a professional and respectful manner.
• Using prescription knowledge to review pharmacy submitted documentation against submitted claim data.
• Assessing and producing detailed descriptions of pharmacy operations and procedures.
• Making confirmation calls to pharmacies prior to audit date and personally handling audit reschedules.
• Performing other duties and responsibilities as assigned

Benefits

• Health & Welfare Benefits: Comprehensive plans tailored to your needs, effective from day one.
• Retirement Savings: Robust programs to help you secure your financial future.
• Employee Discounts: Access to a wide range of discounts on merchandise, services, travel, and more.
• Career Growth Opportunities: Paths for advancement within a global organization.
• Paid Training: Learn while you earn with award-winning learning platforms.
• Paid Time Off: Competitive PTO packages to help you recharge.
• Great Work Environment: Join an award-winning culture that values diversity and inclusion.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed