Search By
More Search Results

Medical Review Auditor Analyst II

Newark, NJ | Full Time
10 Days Ago

Job Description

About Conduent

  • 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.


Job Description

Pharmacy Claim Auditor -

 

Conduent Payment Integrity Solutions performs in-depth pharmacy audits on behalf of our healthcare payer clients.  As a Pharmacy Claims Auditor/Reviewer, you’ll be tasked with examining a wide variety of pharmacy records against our client’s 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 is a position that will require weekly national travel up to approximately 25%. All travel is booked through the Conduent travel application and booked using a corporate credit card that the successful applicant will apply for upon the start of their employment. You will be provided a company laptop, equipment and special software to conduct pharmacy audits.  

 

 

Position Responsibilities -

  • Examine and interpret pharmacy records against submitted claim 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.                     
  • Responsible for covering incoming phone calls for a portion of the day.
  • Process incoming and outgoing correspondence as required.
  • Other duties and responsibilities as assigned.

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

 

 

 

 

 

 

 


Closing

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. You may also click here to access Conduent’s ADAAA Accommodation Policy.

 

At Conduent, we value the health and safety of our associates, their families and our community. Under our current protocols, we do not require vaccination against COVID for most of our US jobs, but may require you to provide your COVID vaccination status, where legally permissible.