Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of …
Skills: Pharmacy claims auditing, Pharmacy records examination, Prescription knowledge, Regulatory compliance, Data analysis
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Other, Full-time
professional certificate
Health insurance, Dental insurance, Vision insurance, Retirement savings plan, Life insurance, Disability insurance
Posted 3d ago
~40 hrs/week
Responsibilities
The Pharmacy Claims Auditor examines pharmacy records against submitted claim data to ensure accuracy and compliance with regulations. They also conduct onsite and desktop audits while maintaining professional communication with clients and pharmacy staff.
Requirements
Candidates must hold a National CPhT certification and possess extensive retail pharmacy experience. The role requires a valid driver's license, a reliable vehicle for travel, and proficiency in Microsoft Office.
Full job description
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Pharmacy Claims Auditor CPhT
Do you have a CPhT certification?
Would you like to audit pharmacy claims for accuracy?
About the Role
Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against our client’s pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct "on-site" pharmacy audits.
Responsibilities
Examining and interpreting pharmacy records against submitted claim data for potential discrepancies.
Utilizing specific client instructions, federal and state regulations, and standards of practice to properly access pharmacy documentation.
Researching board of pharmacy regulations, and state/federal laws as they relate to prescription requirements and pharmacy practices.
Responding to pharmacy calls regarding audit results and dealing with clients periodically to report audit results.
Conducting Onsite and Desktop and Credentialing Audits in a professional and respectful manner.
Using prescription knowledge to review pharmacy submitted documentation against submitted claim data.
Assessing and producing detailed descriptions of pharmacy operations and procedures.
Making confirmation calls to pharmacies prior to audit date and personally handling audit reschedules.
Performing other duties and responsibilities as assigned
Requirements
Have National CPhT Certification through the Pharmacy Technician Certification Board (PTCB). Or be able to obtain one within the first few months.
Have extensive “retail” pharmacy experience.
Be living in commutable distance to the assigned territory (New Orleans, LA; Charlotte, NC; Louisville, KY; St. Louis, MO; or Indianapolis, IN; Cincinnati, OH.)
Have valid driver's license and have a reliable car to visit pharmacies for audits in the local geography.
Be able to travel overnight/flight 1 week/month (25%).
Be proficient with Windows and Microsoft Office.
Be able to stand for long periods of time (Up to 8 hours).
Be able to lift heavy boxes (about 20 lbs.) containing prescription records. (Most records are electronic.)
Flexible Working
At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too. In this role, you can expect the following working conditions:
Hybrid work: Will be working from home 25% of the month and will be working in the field doing audits at different pharmacy locations 75% of the month.
Working for You
We offer perks and rewards designed to support you:
Health & Welfare Benefits: Comprehensive plans tailored to your needs, effective from day one.
Retirement Savings: Robust programs to help you secure your financial future.
Employee Discounts: Access to a wide range of discounts on merchandise, services, travel, and more.
Career Growth Opportunities: Paths for advancement within a global organization.
Paid Training: Learn while you earn with award-winning learning platforms.
Paid Time Off: Competitive PTO packages to help you recharge.
Great Work Environment: Join an award-winning culture that values diversity and inclusion.
Join Us:
At Conduent, we are united by a shared mission. We understand that our success is driven by the success of our associates. When you join us, you’ll find opportunities to:
Bring your authentic self to work every day.
Grow and thrive both personally and professionally.
Make a meaningful impact with our clients, in our communities, and for the millions of people we serve.
With a large workforce across 24 countries, we’re proud to foster a truly global culture—one that supports well-being, values every contribution, and empowers our people to grow both personally and professionally.
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is ($57,000).
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.
Conduent delivers digital business solutions and services spanning the commercial, government and transportation spectrum – creating valuable outcomes for its clients and the millions of people who count on them. We leverage cloud computing, artificial intelligence, machine learning, automation and advanced analytics to deliver mission-critical solutions. Through a dedicated global team of approximately 55,000 associates, process expertise and advanced technologies, our solutions and services digitally transform our clients’ operations to enhance customer experiences, improve performance, increase efficiencies and reduce costs. We drive progress in every process for our client including disbursing approximately $100 billion in government payments annually, enabling 2.3 billion customer service interactions annually, empowering millions of employees through HR services every year and processing nearly 13 million tolling transactions every day.
Learn more at www.conduent.com
Offices: 100 Campus Dr, Florham Park, New Jersey 07932, US · Avenida Maria Coelho Aguiar, 215, Sao Paulo, SP 05805-000, BR · 101 Yorkshire Blvd, Lexington, KY 40509, US · 40, Bengaluru, Karnataka 560066, IN · ulica Gdanska 47/49, Lodz, LD 90-729, PL
Business Process SolutionsHealthcarePayments and EligibilityTransportationCustomer Experience Managementand Human Capital SolutionsInformation TechnologyService IndustryHealth CareBusiness Development
How many Customer Service & Support jobs are open in Cincinnati, OH right now?
There are currently 2,815 open customer service & support positions in Cincinnati, OH listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Customer Service & Support roles in Cincinnati, OH?
Companies currently hiring include TriHealth, Kroger, Bon Secours Mercy Health, Fifth Third Bank, Lowe's Companies, Inc., among others. Browse the listings above to see every active employer.
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