Program Integrity Auditor â Remote
Program Integrity Auditor â Remote
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$ 50000 - 54000
1 Vacancy
Job Description
Role Responsibilities
This individual will report to the Program Integrity Associate Manager and act as a shared resource in collaboration with various program teams to review both chain and independent pharmacy audit requests.
Principal Accountabilities:
- Responsible for conducting pharmacy claims audits at the request of operations and management teams. May leverage health care providers medical facilities various billing portals and contracting teams as necessary.
- Responsible for collaboration with pharmacy facilities to acquire and review documentation necessary for assessing and validating compliance of claims against program business rules.
- Exercise independent judgment to determine appropriate corrective action of noncompliant claims notify pharmacies of findings and provide instructions on the appropriate corrective action. This can include potential reversal refund or reprocessing of claims.
- Document all details pertaining to claims audits and provide a summary to appropriate management team members.
- Provide interpretation and consultation to project teams on project specific guidelines/instructions and policies and procedures.
- Evaluate applicable regulations/guidelines customer requirements Standard Operating Procedures (SOPs) and project specific guidelines/instructions to assist with planning scheduling conducting reporting and closing internal audit activities as time permits.
- Selfstarter able to carry out job responsibilities with minimal supervision.
- Possess exceptional organizational skills.
- Capable of recognizing operational challenges and collaborating with team to design solutions.
- Requires the ability to handle multiple simultaneous tasks with various deadlines while prioritizing urgent requests.
Required Skills
- High School diploma or equivalent
- Previous experience working in a customer care environment
- Excellent problem solving telephone and communication skills
- Good customer relationship skills
- Ability to exercise independent judgment appropriate discretion and escalate to management as appropriate.
- Ability to rapidly adapt to new technologies and assess their potential impact and usefulness in diverse areas within the company
- Ability to work flexibly with the team to ensure timely delivery of service
- Ability to produce high quality work under pressure and within tight timescales
- An ability to work within tight deadlines and manage time effectively.
- Strong team player with flexible attitude to work priorities.
- Excellent computer skills (MS Office applications)
Education & Experience Preferred:
- HIPPA certified
- Bachelors Degree Preferred
- Ability to interpret Explanation of Benefits (EOB)
- Previous auditing experience
- Pharmacy Technician experience
IQVIA is a leading global provider of clinical research services commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at
IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability status as a protected veteran or any other status protected by applicable law. potential base pay range for this role is $50000$54000 annually. The actual base pay offered may vary based on a number of factors including jobrelated qualifications such as knowledge skills education and experience; location; and/or schedule (full or parttime). Dependent on the position offered incentive plans bonuses and/or other forms of compensation may be offered in addition to a range of health and welfare and/or other benefits.
Employment Type
Full-Time
