Third Party Audit Analyst

CVS Health; United States; Remote; USD 43,000 - 94,000; Full time

Job summary

An established industry player is seeking a detail-oriented Third Party Audit Analyst to enhance their auditing processes. This role involves reconciling transactions, managing audits, and implementing process improvements to mitigate bad debt. The ideal candidate will possess strong analytical skills and experience with MS Office and SQL. Join a dynamic team dedicated to transforming health care and making a meaningful impact in the lives of millions. With a commitment to employee wellness, this company offers a range of benefits and a supportive work environment.

Benefits

Affordable medical plan options

401(k) plan with company contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Paid time off

Tuition assistance

Qualifications

• 1+ years of experience in MS Office Access and Excel.
• Proficiency in SQL and analytical skills required.

Responsibilities

• Reconcile 835 transactions against expected audit recoveries.
• Manage Month End processes and build standardized audit reporting.
• Conduct analysis on Third Party Audit activities.

Skills

MS Office Access

Excel

SQL

Analytical Skills

Communication Skills

Education

High School Diploma or GED

Bachelor’s Degree in a technical or business field

Tools

RxConnect System

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary:

The Third Party Audit Analyst is a subject matter expert in the insurance industry and CVS/pharmacy accounts receivable processes for Federal and State Government, along with Commercial payers, paying for scripts dispensed at CVS/pharmacy Retail locations. The Analyst makes business decisions based upon analytics of Pharmacy Audits to reduce bad debt, eliminate legal risk, and ensure compliance to all federal/state requirements and CVS Health obligations.

The Third Party Audit Analyst will focus on Monthly reconciliation and write off's along with building and utilizing ADHOC reporting. This role will focus on performing analysis and root cause diagnosis on various Third Party Audit activities around the top audit bad debt drivers, payer/plan dynamics and month-end procedures. The Analyst will make recommendations for and implement process improvements with payers and/or CVS Health systems and operations. This function supports the goals of recognizing and controlling bad debt through process enhancements and focused efforts in the timely resolution of all audits.

Key Responsibilities:

• Reconciling 835 transactions against expected audit recoveries.
• Managing Month End processes.
• Build & run standardized audit reporting.
• Managing State Funded (Medicaid FFS) audit processes end-to-end.

Required Qualifications:

• 1+ years of MS Office Access & Excel experience.

Preferred Qualifications:

• 3+ year experience with RxConnect System.
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group – directors, managers, colleagues, and external entities.
• Proficiency with SQL.
• Independent problem solver with a strong desire to learn new skills.
• 1+ years of analytics experience.
• Preferred EST Time Zone

Education:

• Verifiable High School Diploma or GED required
• Bachelor’s Degree in a technical or business field preferred or relevant work experience

Anticipated Weekly Hours

40

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary:

The Third Party Audit Analyst is a subject matter expert in the insurance industry and CVS/pharmacy accounts receivable processes for Federal and State Government, along with Commercial payers, paying for scripts dispensed at CVS/pharmacy Retail locations. The Analyst makes business decisions based upon analytics of Pharmacy Audits to reduce bad debt, eliminate legal risk, and ensure compliance to all federal/state requirements and CVS Health obligations.

The Third Party Audit Analyst will focus on Monthly reconciliation and write off's along with building and utilizing ADHOC reporting. This role will focus on performing analysis and root cause diagnosis on various Third Party Audit activities around the top audit bad debt drivers, payer/plan dynamics and month-end procedures. The Analyst will make recommendations for and implement process improvements with payers and/or CVS Health systems and operations. This function supports the goals of recognizing and controlling bad debt through process enhancements and focused efforts in the timely resolution of all audits.

Key Responsibilities:

• Reconciling 835 transactions against expected audit recoveries.
• Managing Month End processes.
• Build & run standardized audit reporting.
• Managing State Funded (Medicaid FFS) audit processes end-to-end.
• Assist in developing audit risk mitigation strategies.

Required Qualifications:

• 1+ years of MS Office Access & Excel experience.

Preferred Qualifications:

• 3+ year experience with RxConnect System.
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group – directors, managers, colleagues, and external entities.
• Proficiency with SQL.
• Independent problem solver with a strong desire to learn new skills.
• 1+ years of analytics experience.
• Preferred EST Time Zone

Education:

• Verifiable High School Diploma or GED required
• Bachelor’s Degree in a technical or business field preferred or relevant work experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/01/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.