Pharmacy Claims Auditor CPhT

About the Role

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

Key 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 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 dates and handling audit reschedules.
• Performing other duties and responsibilities as assigned.

Requirements & Tech Stack

• CPhT Certification through the Pharmacy Technician Certification Board (PTCB), or ability to obtain one within the first few months.
• Extensive "retail" pharmacy experience.
• Ability to live in a commutable distance to assigned territories (New Orleans, LA; Charlotte, NC; Louisville, KY; St. Louis, MO; or Indianapolis, IN; Cincinnati, OH.)
• Valid driver's license and a reliable car for on-site audits.
• Ability to travel overnight/flight 1 week/month (25%).
• Proficient with Windows and Microsoft Office.
• Ability to stand for long periods of time (up to 8 hours).
• Ability to lift heavy boxes (about 20 lbs.) containing prescription records (most records are electronic).

Flexible Working

• Hybrid work: 25% from home, 75% in the field doing audits at different pharmacy locations.

Qualifications

• National CPhT Certification through the Pharmacy Technician Certification Board (PTCB).
• Extensive "retail" pharmacy experience.
• Proficient with Windows and Microsoft Office.