Do you have a CPhT certification?

Would you like to audit pharmacy claims for accuracy?

About the Role

Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor, you will examine a wide variety of pharmacy records against our client's pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct "on-site" pharmacy audits.

Responsibilities

• 
  Examining and interpreting pharmacy records against submitted claim data for potential discrepancies.
• Utilizing specific client instructions, federal and state regulations, and standards of practice to properly access pharmacy documentation.
• Researching board of pharmacy regulations, and state/federal laws as they relate to prescription requirements and pharmacy practices.
• Responding to pharmacy calls in regard to audit results and dealing with clients periodically to report audit results.
• Conducting Onsite and Desktop and Credentialing Audits in a professional and respectful manner.
• Using prescription knowledge to review pharmacy submitted documentation against submitted claim data.
• Assessing, and producing detailed descriptions of pharmacy operations and procedures.
• Making confirmation calls to pharmacies prior to audit date and personally handling audit reschedules.
• Performing other duties and responsibilities as assigned.

Requirements

• 
  Have National CPhT Certification through the Pharmacy Technician Certification Board (PTCB). Or, be able to obtain one within the first few months.
• Have extensive retail pharmacy experience.
• Be living in commutable distance to the assigned territory (Newark, NJ)
• Have valid driver's license and have a reliable car to visit pharmacies for audits in the local geography.
• Be able to travel overnight/flight at least 25% (1 week/month) and possibly up to 50% (2 weeks/month).
• Be proficient with Windows and Microsoft Office.
• Be able to stand for long periods of time (Up to 8 hours).
• Be able to lift heavy boxes containing prescription records.

Flexible Working

At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too.
In this role, you can expect the following working conditions:

• 
  Hybrid work: Work in a way that allows you to work from home during portions of your week and also have time onsite to connect with other team members and business leaders.

Working For You

Perks and rewards designed for you:

• 
  Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.
• Retirement Savings: We will support you as you save for your future.
• Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Paid Training: Earn while you learn, and continue to grow with access to award-winning learning platforms throughout your Conduent career.
• Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.
• Great Work Environment: We are proud of our award-winning culture and the recognition we've received for our diversity efforts.

Join Us

At Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates. We strive to create a culture where you can:

Bring your authentic self to work
Grow and thrive, both personally and professionally
Make a difference with our clients, in our communities, and with the millions of people we support

When you join Conduent, you are engaged in creating the future - both our company's and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and inspire you to be the best!

***Please also fill-out the Job Questionnaire on Conduent's Career website.***