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Pharmacy Compound Claims Auditor

at CVS Health

Posted: 5/16/2019
Job Reference #: 999519BR
Keywords: auditor

Job Description

Job Title :
Pharmacy Compound Claims Auditor
Job ID :
999519BR
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Audit
Description :
Job Description
As the pharmacy compound claims auditor, you are responsible for reviewing all compound claims. You will be expected to understand the various compounded sterile and non-sterile compounded dosage forms, compound math calculations and pharmacies contract requirements as they relate to compounded medications. In addition, the compound claims reviewer is responsible for handling various internal and external partner claim review requests as they relate to compounded claims and any ad hoc requests. Additionally, the pharmacy compound claims auditor is responsible for handling such requests from start to finish including oversight of the claim review process and architecture, conducting pharmacy outreaches in conjunction with other team members, claim review quality control, summarizing and finalizing claim review results while ensuring the claim is correctly processed as a result of the review.

Required Qualifications
- 2+ years of professional experience, preferably in a pharmacy claims role
- Certified Pharmacy Technician License

Preferred Qualifications
- Knowledge of PBM industries
- 2+ years of Pharmacy experience including compounding
- Knowledge of CVS Health (or other Pharmacy Benefit Management) claims processing systems
- Excellent verbal and written communication skills
- Strong math skills
- Ability to work and make decisions independently with a self-starter mentality
- Comfortable with confrontation and able to diffuse situations independently

Education
High school diploma/GED required. Bachelors degree preferred.

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!