- Conduent (Los Angeles, CA)
- …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
- CVS Health (Scottsdale, AZ)
- … claims submitted through the CVS Health claims processing systems. The Pharmacy Claims Auditor will identify and rectify claim inaccuracies that ... to not only help people get well, but help them stay well in body, mind and spirit. The Pharmacy Claims Reviewer is responsible for reviewing pharmacy … more
- CVS Health (Phoenix, AZ)
- …as part of CVS Caremark's extensive Pharmacy Audit division. The Medicare Pharmacy Claims Auditor will administer assigned Medicare Part-D Compliance ... Audit Programs, review pharmacy submitted Medicare claims , make independent decisions, and call network pharmacies to audit submitted information and communicate… more
- Prime Therapeutics (San Diego, CA)
- …fuels our passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in Southern California) **Job Description** The Onsite ... Pharmacy Auditor travels to pharmacy ...in accordance to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest… more
- HUB International (Chicago, IL)
- …The PBM Auditor is responsible for conducting comprehensive audits of Pharmacy Benefit Managers (PBMs) to ensure contractual compliance, accurate claims ... Microsoft Excel (advanced functions) and SQL. + Familiarity with PBM platforms and claims adjudication systems. + Strong understanding of pharmacy billing and… more
- Humana (Phoenix, AZ)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment, pharmacy knowledge a plus + Certified Coder (CPC, CRC, and/or CMC) + Experience… more
- Albany Medical Center (Albany, NY)
- …of America) Salary Range: $65,102.17 - $100,908.37 Under the direction of the Director of Pharmacy the Pharmacy Revenue Integrity Auditor will serve as a ... processes. They are responsible for ensuring the accuracy and compliance of pharmacy billing practices by reviewing patient records, medication orders, and insurance… more
- Medical Mutual of Ohio (OH)
- …+ Ability to utilize certified HEDIS software. + Ability to analyze clinical, claims , pharmacy , encounter, and quality measurement data. + Advanced knowledge of ... + Ability to utilize certified HEDIS software. + Ability to analyze clinical, claims , pharmacy , encounter, and quality measurement data. + Advanced knowledge of… more
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