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Pharmacy Claims Auditor CPhT

Chicago, IL

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Description Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve. We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world. Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. . Pharmacy Claims Auditor CPhT Position Responsibilities: Examine and interpret pharmacy records against submitted claims data for potential discrepancies. Utilize specific client instructions, federal and state regulations and standards of practice to properly access pharmacy documentation. Research board of pharmacy regulations as well as state and federal laws as they relate to prescription requirements and pharmacy practices. Respond to pharmacy calls in regards to audit results. Deal with clients periodically to report audit results. Conduct onsite and desktop and credentialing audits in a professional and respectful manner. Use prescription knowledge to review pharmacy submitted documentation against submitted claim data. Assess and produce detailed descriptions of pharmacy operations and procedures. Make confirmation calls to pharmacies prior to audit date. Personally handle audit reschedules. Must be able to stand for long periods of time (up to 8 hours). Must be able to lift heavy boxes containing prescription records. Call Center Assistance Responsible for covering incoming phone calls for a portion of the day. Process incoming and outgoing correspondence as required. Required Skills National CPhT Certification through the Pharmacy Technician Certification Board (PTCB) 5 years retail pharmacy experience Long Term Care / Infusion pharmacy experience favorable Proficiency in Windows and Microsoft Office preferred All other duties as assigned. Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

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