Pharmacy Claims Auditor CPhT

Conduent; Cincinnati (OH); Hybrid; USD 51,000 - 63,000; Full time

Benefits offered by this job

Health & welfare benefits

Retirement savings program

Employee discounts

Career growth opportunities

Paid training

Paid time off

Great work environment

Job summary

Conduent is seeking a Pharmacy Claims Auditor CPhT to audit pharmacy claims for accuracy and to conduct on-site audits for our healthcare payer clients. The role requires national CPhT certification (PTCB) or ability to obtain it, extensive retail pharmacy experience, and the ability to travel to multiple territories.

You will audit records against claim data, consult client instructions and regulations, and report audit results.

Qualifications

• National CPhT certification or ability to obtain within the first few months.
• Extensive retail pharmacy experience.
• Live within commutable distance to the assigned territory (multiple U.S. cities including Cincinnati).
• Valid driver's license and reliable car to visit pharmacies for audits.
• Willingness to travel overnight roughly 1 week per month (25%).
• Proficient with Windows and Microsoft Office.

Responsibilities

• Audit pharmacy records against submitted claim data for discrepancies.
• Follow client instructions and regulations to access documentation.
• Research boards and laws related to prescription requirements and pharmacy practices.
• Communicate audit results to pharmacies and clients.
• Conduct onsite and desktop audits and credentialing.
• Review documentation against claims using prescription knowledge.
• Provide detailed descriptions of pharmacy operations and procedures.
• Coordinate confirmations and reschedules pre-audit.
• Perform other duties as assigned.

Skills

Retail pharmacy experience

Windows

Microsoft Office

Education

National CPhT Certification (PTCB)

Job description

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 CPhT, 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.

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 (New Orleans, LA; Charlotte, NC; Louisville, KY; St. Louis, MO; or Indianapolis, IN; Cincinnati, OH.)
• Have valid driver's 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, you’ll 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 a large workforce across 24 countries, we’re proud to foster a truly global culture— one that supports well-being, values every contribution, and empowers our people to grow both personally and professionally.

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 performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In 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 ($57,000).