Pharmacy Claims Auditor CPhT
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Job Location:
Philadelphia, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Pharmacy Claims Auditor CPhT
Do you have a CPhT certification
Would you like to audit pharmacy claims for accuracy
About the Role
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 clients 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.
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
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 drivers license and have a reliable car to visit pharmacies for audits in the local geography.
- Be able to travelovernight/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.)
Flexible Working
At Conduent we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too.
In this role you can expect the following working conditions:
- Hybrid work: Will be working from home 25% of the month and will be working in the field doing audits at different pharmacy locations 75% of the month.
Working for You
We offer perks and rewards designed to support you:
- 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.
Join Us:
At Conduent we are united by a shared mission. We understand that our success is driven by the success of our associates. When you join us youll find opportunities to:
- Bring your authentic self to work every day.
- Grow and thrive both personally and professionally.
- Make a meaningful impact with our clients in our communities and for the millions of people we serve.
With over 50000 associates in 24 countries youll be part of a global team thats shaping the future for the company and for yourself.
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position actual salaries will vary and may be above or below the range based on various factors including but not limited to location experience and addition to base pay this position based on business need may be eligible for a bonus or addition Conduent provides a variety of benefits to employees including health insurance coverage voluntary dental and vision programs life and disability insurance a retirement savings plan paid holidays and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is ($57000).
Required Experience:
IC
Key Skills
- Auditing
- Time Management
- ICD-10
- Accounting
- Component evaluation
- Workers' Compensation Law
- SOX
- Microsoft Excel
- CPT Coding
- Internal Audits
- Medicare
- Bookkeeping
About Company
COVID-19 presents an unprecedented and challenging situation for all of us. At Conduent, our top priority is to protect our associate base and the communities where we live and work, while continuing to serve and help our clients at a time when they need us most. We’d like to thank ev ... View more
