The Third Party Audit Coordinator requires a person with solid communication skills, both written and oral. The candidate should have solid organizational, interpersonal and time management skills. They will be required to resolve and complete Third Party audit requests while executing project ownership for 1 concurrent department projects. In addition the Third party Audit Coordinator will maintain the following principle responsibilities:
Perform many different audits while assisting pharmacy staff and field management to resolve and complete audit requests and inquiries. Closely monitor current processes and SOP’s to maximize efficiency and drive innovation.
Ability to digest shifts in work assignments to account for seasonal workload shift or unforeseen events impacting daily workload
Provide timely and accurate documentation to support the administration of prescription claims to the PBM or Plan in accordance with HIPAA and audit client requirements.
Evaluate audit discrepancies against BOP, State/Federal and Payer contract language to ensure audit results comply with required guidelines.
Ability to self-report on audit trend analysis and provide insight to management for operational or financial
considerations. Ability to analyze trends and develop strategies to ensure continuous improvement of results.
Coordinate audit activities with audit clients and interact with store support and management staff while maintaining departmental goals, policies and initiatives.
Perform accurate and timely data entry and data movement into internal reporting tools and databases.
Take prompt action to review, diagnose and understand new audit requests
Communicate with audit payers, firms and internal departments on audit activities & observations
Perform timely resolution to requests received from internal departments, customers, audit entities, or regulatory agencies.
Promotes a cooperative and respective relationship with other personnel, entities or agencies while maintaining professionalism at all times
Motivated to identify ways to improve audit process and results influencing downstream financial results for Third Party Department
Possess project management skills to drive improvement in key department metrics
Ability to work under pressure with minimal supervision and demonstrates excellent decision making skills
Demonstrates professional growth through independent study, training, and certificate opportunities
1 years of professional work experience, preferably in a corporate healthcare or pharmacy setting
1 years of MS Office experience
Excellent verbal and written communication skills and the ability to interact professionally with a diverse group directors, managers, colleagues, and external customers.
Driven and self-motivated to perform at a high level.
Ability to prioritize, structure timelines and project plans, engage and align stakeholders across multiple groups, define measures of success, incorporate feedback and analyze results across multiple work streams
High level of independent judgment and initiative.
Excellent critical thinking, organizational and time management skills with a strong attention to detail, accuracy, and follow through.
Ability to complete routinely assigned work based on productivity standards (SLA) with minimal supervision
Previous experience consisting of auditing, healthcare, compliance, claims processing, account management, project management, retail pharmacy or PBM experience.
Verifiable High School Diploma or GED required. Bachelor’s degree highly preferred.
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at **** and EEO IS THE LAW SUPPLEMENT at ****
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking Advice and Counsel at mailto:Advice&****
CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please ****. For technical issues with the Virtual Job Tryout assessment, ****. Please note that we only accept resumes via our corporate website: ****