Pharmacy Claims Auditor CPhT Job Detroit Michigan USA,Healthcare

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.

Pharmacy Claims Auditor CPhT

Do you have a CPhT certification?

Would you like to audit pharmacy claims for accuracy?

About the Role

Conduent Payment Integrity Solutions performs in-depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against our client’s pharmacy claim data to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct "on-site" pharmacy audits.

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.

Requirements

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 (Detroit MI).

Have a valid driver's license and 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.

Working For You

Perks and rewards designed for you:

Health and Welfare Benefits:
Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.

Retirement Savings:
We will support you as you save for your future.

Employee Discounts:
We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.

Career Growth Opportunities:
We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.

Paid Training:
Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.

Paid time off:
We provide attractive paid time off packages designed for you to enjoy your life away from work.

Great…