Pharmacy Claims Auditor CPhT

Conduent; Detroit (MI); Hybrid; USD 51,300 - 62,700; Full time

Benefits offered by this job

Health and Welfare Benefits

Retirement Savings

Employee Discounts

Career Growth Opportunities

Paid Training

Paid Time Off

Great Work Environment

Job summary

An innovative firm is seeking a Pharmacy Claims Auditor to ensure the accuracy of pharmacy claims for healthcare clients. This role involves examining pharmacy records, conducting audits, and ensuring compliance with regulations. You'll work both remotely and on-site, providing an engaging work environment that values individuality. The company offers extensive benefits, career growth opportunities, and a supportive culture where you can thrive. Join a team dedicated to making a difference in the healthcare industry and enjoy a fulfilling career while contributing to exceptional client outcomes.

Qualifications

• CPhT certification required; retail pharmacy experience preferred.
• Proficient with Windows and Microsoft Office for documentation.

Responsibilities

• Audit pharmacy claims for accuracy and compliance with regulations.
• Conduct on-site audits and communicate findings to clients.

Skills

Pharmacy Claims Auditing

Regulatory Research

Communication Skills

Problem-Solving

Education

CPhT Certification

Tools

Microsoft Office

Windows

Job description

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.

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 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

1. Examining and interpreting pharmacy records against submitted claim data for potential discrepancies.
2. Utilizing specific client instructions, federal and state regulations, and standards of practice to properly access pharmacy documentation.
3. Researching board of pharmacy regulations, and state/federal laws as they relate to prescription requirements and pharmacy practices.
4. Responding to pharmacy calls regarding audit results and dealing with clients periodically to report audit results.
5. Conducting Onsite and Desktop and Credentialing Audits in a professional and respectful manner.
6. Using prescription knowledge to review pharmacy submitted documentation against submitted claim data.
7. Assessing and producing detailed descriptions of pharmacy operations and procedures.
8. Making confirmation calls to pharmacies prior to audit date and personally handling audit reschedules.
9. Performing other duties and responsibilities as assigned.

Requirements

1. Have National CPhT Certification through the Pharmacy Technician Certification Board (PTCB). Or, be able to obtain one within the first few months.
2. Have extensive “retail” pharmacy experience.
3. Be living in commutable distance to the assigned territory (Detroit MI).
4. Have a valid driver's license and a reliable car to visit pharmacies for audits in the local geography.
5. Be able to travel overnight/flight 1 week/month (25%).
6. Be proficient with Windows and Microsoft Office.
7. Be able to stand for long periods of time (up to 8 hours).
8. 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:

1. 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

Perks and rewards designed for you:

1. Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.
2. Retirement Savings: We will support you as you save for your future.
3. Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
4. Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
5. Paid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.
6. Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.
7. Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.

Join Us

At Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates. We strive to create a culture where you can:

Bring your authentic self to work
Grow and thrive, both personally and professionally
Make a difference with our clients, in our communities, and with the millions of people we support

When you join Conduent, you are engaged in creating the future - both our company’s and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and inspire you to be the best!

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.

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.

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 [e-mail] may alsoclick here to access Conduent's ADAAA Accommodation Policy.

At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.