- The Cigna Group (Detroit, MI)
- The Pharmacy Auditor is responsible for identifying pharmacy audit risks using analytical skills and audit tools, and for developing and executing audit ... of procedures necessary to address those risks. The Staff Auditor will complete audits to address identified risks and...willing to travel locally and throughout the US for pharmacy audits up to 50% **ESSENTIAL FUNCTIONS:** + Perform… more
- UPMC (Pittsburgh, PA)
- …prescribing of controlled substances, or medically appropriate services. + Query medical and/or pharmacy claims and conduct a risk assessment by performing data ... referrals from Pharmacy Benefit Manager (PBM) by analyzing medical and pharmacy claims and associated clinical documentation in HealthPlaNET, Mars, Epic… more
- AmeriHealth Caritas (Philadelphia, PA)
- …integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. ... communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case...will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all… more
Locations:
Pennsylvania,
Michigan
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