Pharmacy Audit Assistant - Senior
Cumberland , Rhode Island
April 04, 2017
As a Senior Audit Assistant, you will be responsible for administering audit related requests in support of the Third Party Audit department. The CVS Health Third Party Audit department serves as the managing interface concerning pharmacy audits from State Medicaid, Medicare Part D, and commercial insurance plan’s and PBM’s. Therefore, you will gain a deep understanding of Pharmacy, PBM business, customers, audit firms,audit entities and clients. Prior knowledge of these fields, especially pharmacy, is strongly preferred. Additionally, you must have solid written and verbal communication skills, strong organization skills, interpersonal skills,and time management skills.

Your responsibilities will include:
- Providing timely and accurate documentation to support the administration of prescription claims to the PBM or Plan in accordance with HIPAA and audit client requirements
- Coordinating audit activities with audit clients and interacting with store support and management staff while maintaining departmental goals, policies and initiatives
- Taking prompt action to review, diagnose and understand new audit requests
- Performing accurate and timely data entry into internal reporting tools and databases
- Assisting Pharmacy staff and field management to resolve and complete Third Party Audit requests and inquiries
- Performing timely resolution to requests received from internal departments, customers, audit entities, or regulatory agencies
- Closely monitoring current processes and Standard Operating Procedures (SOP’s) to maximize efficiency and drive innovation
- Reviewing audit issues with Audit Consultant and Sr. Audit Consultant management as required
- Managing multiple audits simultaneously while delivering within required varying deadlines
- Proactively identifying audit trends and raises possible solutions to their direct Supervisor and/or Sr. Manager, Payer Audit
- Performing proactive internal claim reviews through daily audits,self-audits, reactive audits
- Establishing trend reporting and work towards issue resolution to prevent future re-occurrences


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