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Network Management Analyst
CVS HealthMedicare Pharmacy Claims Auditor conducting compliance audits and verifying pharmacy claims submissions for CVS Health. Collaborates with pharmacies and internal teams to maintain accuracy and compliance standards.
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- 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.
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
ATS Keywords
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Hard Skills & Tools
pharmacy claims processingdata entryaudit analysiscompliance reviewMedicare audit programsMicrosoft ExcelMicrosoft AccessSQL
Soft Skills
communicationcollaborationorganizational skillsproblem-solving
Certifications
Pharmacy Technician Certification Board (PTCB)High School DiplomaGED