CVS Health

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Manager - Third Party Audit

at CVS Health

Posted: 1/10/2019
Job Reference #: 921436BR

Job Description

Job Title :
Manager - Third Party Audit
Job ID :
Location :
RI - Cumberland
Street Address :
200 Highland Corporate Drive
Category :
Description :
Job Description
Would you like to be part of a dynamic Audit team at Fortune 7 CVS Health? As the Manager, Third Party Payer Audit, you will be responsible for managing retail pharmacy audits including but not limited to: onsite, desktop and daily claim audits. You will lead a team of Sr. Assistants and Sr. Coordinators responsible for the timely processing and refutation of prescription claims paid by Third Party Prescription Benefit Managers (PBMs), Health Care Insurers, State & Federal Medicaid Programs, and Medicare Part B and Part D. Additionally, you will be responsible for continued process improvement and innovation that continually drives improvement in the audit refutation and response processes.

You will also interact and work cross-functionally with team members of Field Management, Third Party Account Management, Third Party Business Support & Innovation, Payer Relations, Pharmacy Operations, Privacy Office, Legal, Compliance, and Government Affairs.

Required Qualifications
You have 5+ years of demonstrated strong organizational and project/time management skills.
* You have the ability to lead and influence others by creating a strong case for action using analytical findings.
* You have the ability to identify apparently disparate trends, complete the appropriate analysis and propose solution(s) to reduce or eliminate the audit risk going forward.
*You possess strong Excel skills.

Preferred Qualifications
* You are able to work effectively with teams and independently in a dynamic fast-paced environment.
* You must be able to effectively communicate with the pharmacy team, field and Sr. TP Audit Manager, present information to a group and promptly respond to questions from pharmacy, field, and managers.
* You have intermediate Microsoft Word and Access skills.
* You have the ability to maintain a high level of consistency while working with team members.
* You are able to work cross functionally with key stakeholders to ensure complete alignment on issues and their potential solutions.
* You have strong leadership skills.
* You have retail pharmacy experience and knowledge of pharmacy industry standards.

High School diploma or GED required along with equivalent years of experience. Bachelor degree preferred.

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking Advice and Counsel

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!