Pharmacy Claims Auditor / Medical Svc Sr Specialist
DETROIT MI 48208
**Pharmacy Claims Auditor / Medical Svc Sr Specialist**
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. Learn more at www.conduent.com .
If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
If selected for this position, you will perform in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor / Reviewer, this candidate will be tasked with examining a wide variety of pharmacy records against our clients' pharmacy claim data to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct onsite pharmacy audits.
This position requires nationwide travel, 50% of the time.
+ 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.
+ 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. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form .
**Job** Service Delivery Healthcare
**Primary Location** United States-Michigan-Detroit
**Organization** Commercial Sector
**Unposting Date** Nov 8, 2017, 10:59:00 PM
**Virtual/work from home?** No
**Req ID:** 17019855