- Conduent (Newark, NJ)
- …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 ... 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 … more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Claims Auditor III Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Specialty Plans Auditor III is responsible for planning audits and audit...Preferred Provider Groups (PPG), Specialty Health Plans (SHP) and Pharmacy Benefit Manager (PBM) including LA Care's Claims… more
- Elevance Health (Norfolk, VA)
- ** Pharmacy Internal Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our ... and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The ** Pharmacy Internal Auditor...processes and processes related to enrollment and billing and claims processing, as well as customer service written and… more
- The Cigna Group (Vancouver, WA)
- …contractual requirements. **ESSENTIAL FUNCTIONS** + Perform efficient and effective network pharmacy claims audits to produce results consistent with ... and discretion, may recommend changes in processing procedures. **Job Description** The Pharmacy Technician Auditor is primarily responsible for using analytical… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department + Prepare ... Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department . Prepare ... Job Summary With direction from the Director, the Nurse Auditor /Revenue Integrity Specialist is responsible for auditing itemized charges versus the patient medical… 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
- Health Advocates Network (Coral Springs, FL)
- …! This is a full-time contract position at a nationally recognized independent pharmacy / DME company located in **Coral Springs, FL.** + **Pay Rate: $20.00 per ... group of clinicians to ensure the documentation is clinically sufficient before claims are submitted to insurance companies for payment. Prioritize workloads to… more
- CVS Health (Springfield, IL)
- …resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working ... role. This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking,...knowledge base around pharmacy claim adjudication principles, such as (but not limited… more
- CVS Health (Nashville, TN)
- …adjudication principles, such as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review and ... respond to all the auditor questions in a short window of time. This...will possess the following: . A deep understanding of pharmacy claim adjudication . Ability to actively seek new… more
- Elevance Health (Tampa, FL)
- …effective internal controls. **How you will make an impact:** + Detailed pharmacy claims validation + Interpreting and managing audit requirements, ie, ... background. **Preferred Skills, Capabilities, and Experiences:** + Strong expertise in pharmacy claims and reimbursement processes + Proven time management… more