Analyst, Network Management

Responsibilities

• Conduct outbound calls to network pharmacies to verify claim information
• Distribute audit requests and documentation requirements to pharmacies
• Review prescriptions and supporting documents to ensure compliance with CMS and CVS Health contractual requirements
• Analyze incoming pharmacy documentation and accurately enter data into internal audit systems
• Respond to pharmacy inquiries related to Medicare audit programs
• Track and report progress on assigned audit activities
• Collaborate with internal stakeholders to align on audit objectives and business priorities

• 1+ years of experience in a pharmacy or Pharmacy Benefit Management (PBM) environment (5+ years preferred)
• 2+ years of experience with pharmacy claims processing systems
• Working knowledge of CMS Medicare Part D compliance regulations
• Advanced technical skills, including Microsoft Excel, Access, and SQL
• Pharmacy Technician Certification Board (PTCB) certification preferred
• High School Diploma or GED required

• pharmacy claims processing
• data entry
• audit analysis
• compliance review
• Microsoft Excel
• Microsoft Access
• SQL

• communication
• collaboration
• organizational skills
• problem-solving

• Pharmacy Technician Certification Board (PTCB)
• High School Diploma
• GED