CVS Health

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Pharmacy Audit Analyst

at CVS Health

Posted: 8/1/2018
Job Reference #: 810687BR

Job Description

Job Title :
Pharmacy Audit Analyst
Job ID :
Location :
RI - Cumberland
Street Address :
200 Highland Corporate Drive
Category :
Description :
Job Description
The Pharmacy Audit Analyst is a subject matter expert for Third Party Audit, retail pharmacy and field operations. The Analyst supports the development and implementation of programs for harmonization with enterprise programs and Third Party Audit. They will support operational synergies between third party audit and departments impacting and influencing pharmacy in the areas of: prescription fulfillment, claim adjudication and pharmacy workflow. They will be responsible for the development and enhancement of pharmacy programs and initiatives to reduce Third Party audit activity and payer reimbursement take backs. This role will collaborate with members of many teams to lend Third Party Audit expertise and help influence synergies within current established programs and processes. This person will represent key Third Party Audit interests with enterprise departments including but not limited to store support, pharmacy operations, payer relations and patient safety.

This person will be heavily involved in problem resolution and ownership of numerous projects. They will be responsible for the identification and management of his/her own individual projects to drive excellence as it relates to third party pharmacy audits. They will need strong problem solving and analytical skills to assess data, identify trends, and develop meaningful operational output. Critical thinking, impacting, and influencing skills will be needed to achieve results in these areas as well as the ability to manage towards value tracking models to bring insight to business and various levels of management. A deep understanding of the business is required to deliver impactful results. The candidate will need strong problem solving and analytical skills to assess data, identify trends, and develop meaningful operational output.

The ideal candidate is someone who has experience fostering problem-solving solutions with multiple stakeholders. They will participate in the development and dissemination of communications that foster knowledge around key audit issues, lead meetings that identify deliverables and stakeholders, and execute objectives in a manner that raises awareness around critical issues to help bring line of sight to solutions to reduce Third Party audit drivers. They should have an understanding of the state legislations that impact and influence third party audit outcome and behaviors.

The primary objectives of this position is to support operation excellence through strategic planning and partnership among various areas within the organization and track monitor progress against predictive models.
- Identify and support objectives to mitigate key areas of audit
- Investigate CVS Pharmacy audit "charge-backs" to determine enterprise wide "best practices"
- Define system enhancement planning, integration and testing
- Clinical support for Third Party audit department
- Establish line of site and value tracking methods for key audit scenarios
- Perform proactive and retrospective quality assurance audit reviews
- Assist in facilitating proactive claim review programs, measuring business impacts and influences
- Identify audit trends, develop reporting and create value tracking models to support initiatives

A successful candidate will evaluate data to draw conclusions, identify cause and effect relationships, to understand impact and influencing processes and provide insight for decision-making. This position requires acquiring a solid understanding of various systems and data repositories, data mining, measuring, tracking, drawing conclusions, recommending potential opportunities for performance improvement. The successful candidate in this position will leverage their operational knowledge and will develop a deeper understanding of our pharmacy business as well as operation processes, in order to best provide strategic recommendations to drive work streams.

Required Qualifications
- 4+ years of pharmacy experience with deep understanding of pharmacy workflow
- 4+ years of MS Office experience

Preferred Qualifications
- Aptitude for learning and understanding computer software
- Ability to plan, test, implement, troubleshoot and evaluate system software
- Knowledge of SQL
- Four (4) years of clinical pharmacy or retail pharmacy support experience
- Clinical/pharmacy or retail pharmacy support knowledge and project management skills
- Ability to be flexible and change direction as needed
- Ability to manage and support multiple projects at one time
- Strong interpersonal, presentation, written and verbal communication skills
- Ability to work cross-functionally to achieve results
- Ability to handle complex, detailed, data-oriented tasks with a high degree of accuracy
- Ability to think and act strategically while providing a lens to value opportunities
- Highly organized, detail oriented, proficient analytical ability, effective listening and presentation skills, and ability to manage complex projects is required
- Advance proficiency in various PC applications including MS Office products (Outlook, Word, Excel, Access, PowerPoint)

Verifiable Bachelor’s Degree or equivalent experience required

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 EEO AA CVS Health

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!