Analyst, Network Management

Jobtailor; Arizona; Hybrid; USD 52,000 - 75,000; Full time

Job summary

Jobtailor is seeking a Pharmacy Audit Support professional in the United States. You will conduct outbound calls to network pharmacies to verify claim information, distribute audit requests, and review prescriptions for CMS and contract compliance.

You will analyze incoming documentation and enter data, while responding to inquiries about Medicare audit programs. The role requires familiarity with pharmacy claims processing systems, strong Excel/Access/SQL skills, and a solid high school level

Qualifications

• 1+ years of experience in a pharmacy or PBM environment (5+ years preferred).
• 2+ years of experience with pharmacy claims processing systems.
• Working knowledge of CMS Medicare Part D compliance regulations.

Responsibilities

• Conduct outbound calls to network pharmacies to verify claim information.
• Distribute audit requests and documentation requirements to pharmacies.
• Review prescriptions and supporting documents to ensure CMS and CVS Health contractual compliance.
• Analyze incoming pharmacy documents and accurately enter data into internal audit systems.
• Respond to pharmacy inquiries related to Medicare audit programs.
• Track and report progress on assigned audit activities.
• Collaborate with internal stakeholders to align on audit objectives and business priorities.

Skills

communication

collaboration

organizational skills

problem-solving

Education

PTCB certification

High School Diploma

GED

Tools

Microsoft Excel

Microsoft Access

SQL

Job description

Responsibilities

• Conduct outbound calls to network pharmacies to verify claim information
• Distribute audit requests and documentation requirements to pharmacies
• Review prescriptions and supporting documents to ensure compliance with CMS and CVS Health contractual requirements
• Analyze incoming pharmacy documentation and accurately enter data into internal audit systems
• Respond to pharmacy inquiries related to Medicare audit programs
• Track and report progress on assigned audit activities
• Collaborate with internal stakeholders to align on audit objectives and business priorities

Requirements

• 1+ years of experience in a pharmacy or Pharmacy Benefit Management (PBM) environment (5+ years preferred)
• 2+ years of experience with pharmacy claims processing systems
• Working knowledge of CMS Medicare Part D compliance regulations
• Advanced technical skills, including Microsoft Excel, Access, and SQL
• Pharmacy Technician Certification Board (PTCB) certification preferred
• High School Diploma or GED required

Hard Skills

• pharmacy claims processing
• data entry
• audit analysis
• compliance review
• Microsoft Excel
• Microsoft Access
• SQL

Soft Skills

• communication
• collaboration
• organizational skills
• problem-solving

Certifications & Qualifications

• Pharmacy Technician Certification Board (PTCB)
• High School Diploma
• GED