Pharmacy Claims Auditor (CPhT) – Hybrid/Field

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

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.