Manager, Corporate Compliance, IC
CVS Health
Pharmacy Reimbursement Administrator
Microsoft 365
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $47,309 - $56,321 per year
Job Level
Mid-LevelSenior
About the role
- Administers technical processes in support of system price setups, electronic funds transfer and remittance setups according to policy
- Ensures appropriate controls and oversight reporting on the end-to-end process. If process controls are absent, the expectation is to identify, define, and implement new ones as needed
- Make decisions regarding the resolution of pharmacy network pricing setup issues. Research pricing inquiries from pharmacies and internal teams
- Develop processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx
- Responsible for pharmacy network rate testing, analysis and impact assessment
- Perform quality assurance to ensure accuracy in pharmacy network rates on an ongoing basis to mitigate the risk of incorrect claims adjudication
- Appropriately identify and escalate improper payments and 835 issues
- Maintenance of department detail work instructions and policies
- Monitoring and reporting of non-compliance relating to overpayments, transaction standard issues and financial regulations
- Provide offset detail to pharmacies impacted in a recovery project prior to receipt of payment and remit
- Responsible for oversight of applicable financial and metric’s reporting, data dictionaries, inquiries, and audits
- Other duties as assigned
Requirements
- Associate Degree preferred or equivalent experience.
- CPhT preferred
- PBM or managed care is preferred, but not required
- Previous testing experience is preferred
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
