Pharmacy Claims Auditor CPhT
Conduent is a company that delivers mission-critical services and solutions for Fortune 100 companies and governments. They are seeking a Pharmacy Claims Auditor to conduct audits on pharmacy claims for accuracy, ensuring compliance with regulations and client instructions.
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
Skills
- 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 (Philadelphia, PA)
- 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.)
Benefits
- 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.
- Bonus or incentive
- Health insurance coverage
- Voluntary dental and vision programs
- Life and disability insurance
- A retirement savings plan
- Paid holidays
- Paid time off (PTO) or vacation and/or sick time
Company Overview
Company H1B Sponsorship