Pharmacy Claims Auditor CPhT

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 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 (San Antonio TX).
• 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

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.

We Offer You

• Health & Welfare Benefits: Comprehensive plans tailored to your needs, effective from day one.
• Retail Savings: Robust programs to help you secure your financial future.
• 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.

Join Us

At Conduent, we are united by a shared mission. We understand that our success is driven by the success of our associates. When you join us, you’ll find opportunities to:

• Bring your authentic self to work every day.
• Grow and thrive both personally and professionally.
• Make a meaningful impact with our clients, in our communities, and for the millions of people we serve.