Pharmacy Claims Auditor CPhT

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

Benefits offered by this job

Health & Welfare

Retirement Savings

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 ensure compliant submission of records. The role includes on-site audits for healthcare payer clients across a defined geography.

The ideal candidate holds a National CPhT Certification (PTCB) and has extensive retail pharmacy experience, with ability to travel 25% and work from multiple sites. Proficiency in Windows and Microsoft Office is required.

Qualifications

• Must have National CPhT certification or obtain within the first months.
• Extensive retail pharmacy experience is required.
• Able to travel overnight/flight ~1 week per month (25%).
• Living within commutable distance to assigned territory in the US (multiple cities).
• Proficient with Windows and Microsoft Office.

Responsibilities

• Examine pharmacy records against submitted claim data for discrepancies.
• Follow client instructions, regulations, and standards of practice when accessing documentation.
• Research board of pharmacy regulations and state/federal laws related to prescriptions.
• Respond to audit results with clients and report outcomes.
• Conduct Onsite, Desktop, and Credentialing Audits professionally.
• Review documentation against claim data using prescription knowledge.
• Produce detailed descriptions of pharmacy operations and procedures.
• Make confirmation calls to pharmacies prior to audit dates and reschedule as needed.
• Perform other assigned duties.

Skills

CPhT certification

Retail pharmacy experience

Travel willingness

Valid driver’s license

Education

National CPhT Certification (PTCB)

Tools

Windows

Microsoft Office

Job description

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 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.)

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).

About Us

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

About the Team

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded: click here to access or download the form. Complete the form and then email it as an attachment to [e-mail]. You may also click here to access Conduent's ADAAA Accommodation Policy.