Salary
$57,000 / YEAR
The Pharmacy Claims Auditor will examine pharmacy records against client claim data to ensure accurate submission, utilizing client instructions, regulations, and standards of practice. Responsibilities also include conducting on-site and desktop audits, researching regulations, and communicating audit results to pharmacies and clients.
Candidates must possess a National CPhT Certification through PTCB or obtain one shortly after hiring, along with extensive retail pharmacy experience. The role requires living within commutable distance of Philadelphia, PA, having a valid driver's license and reliable car for local travel, and the ability to travel overnight up to one week per month.
Pharmacy Claims Auditor CPhT Do you have a CPhT certification?
Would you like to audit pharmacy claims for accuracy?
Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor, you will examine a wide variety of pharmacy records against our client’s pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct "on-site" pharmacy audits.
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
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.) 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: 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.
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.
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. For US applicants: 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 to FTADAAA@conduent.com. You may also click here to access Conduent's ADAAA Accommodation Policy.
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