Pharmacy Claims Auditor CPhT | Hybrid & Field Audits

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

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.