Conduent

Pharmacy Claims Auditor, CPhT

Conduent

full-time

Posted on:

Location Type: Hybrid

Location: Chicago • Illinois • United States

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Salary

💰 $57,000 per year

About the role

  • 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 (Chicago IL)
  • 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.)
Benefits
  • Health & Welfare Benefits: Comprehensive plans tailored to your needs, effective from day one.
  • Retirement Savings: Robust programs to help you secure your financial future.
  • Employee Discounts: Access to a wide range of discounts on merchandise, services, travel, and more.
  • 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.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
pharmacy documentation reviewaudit proceduresdiscrepancy analysisprescription knowledgecredentialing auditsstate regulations researchfederal regulations researchpharmacy operations assessmentclient communicationdata interpretation
Soft Skills
professionalismrespectfulnesscommunicationattention to detailproblem-solvingorganizational skillsinterpersonal skillsadaptabilitytime managementcustomer service
Certifications
National CPhT CertificationPharmacy Technician Certification Board (PTCB)