CVS Health
Scottsdale, Arizona, United States
Client Audit, Government Audits Advisor
Posted over 1 month ago
Job Description
Job Description
CVS Health is currently looking for a dynamic individual to join our team in an Advisor role. This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking, reviewing, researching and assisting with multiple complex audit activities initiated by CMS / States. In this position, the Advisor will work closely with various Government / State auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business.
This position needs to be able to manage many audits at the same time with short turnaround times.
The Advisor will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations, formulary, and accumulation tracking in order to review and respond to all the auditors questions in a short window of time.
This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.
As an Advisor of Client Audit, you will be responsible for the following:
* Work directly with the government auditors, the client and all the internal business areas involved in the audit
* Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities
* Have a working knowledge base of Medicare Part D and the regulations
* Work independently with limited direction from the Sr. Manager
* Coordinate, manage, track the audits from start to closure
* Review and researching all questions from the auditor and client
* Work through and resolve any alleged issues; working strategically and achieving results
* Respond back to the auditor / client
* Raise appropriate at risk items to the Sr. Manager timely
* Documenting correspondence with internal partners, clients, and auditors
* Tracking all audit progress to ensure that all deliverables are provided by due dates
The ideal candidate will possess the following:
* Understanding of pharmacy claim adjudication
* Understanding of pharmacy manufacturer rebates
* Ability to actively seek new ways to grow and be challenged
* Critical thinking which translates into strategic actions
* Easily adapting to change
* Excellent verbal and written communications skills
* Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion. A working contributor responsible for each projects success.
* Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must. Strong tolerance for ambiguity and stress
* Strong ability to maintain attention to detail and organizational skills.
* Strong ability to hold oneself and others accountable for mitigating risk and achieving results
Required Qualifications
-Minimum 5 years of prior relevant experience in audit, project management, or financial advisory role
Preferred Qualifications
-Proficiency in Microsoft Word, Excel, PowerPoint
-PBM experience is also desired
-Knowledge of DBA/SQL and/or SAS
-Minimum 3 years pharmacy claim experience
-CPA, CIA or MBA preferred
Education
BS/BA required or high school diploma/GED and equivalent years of education and experience.
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
CVS Health is currently looking for a dynamic individual to join our team in an Advisor role. This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking, reviewing, researching and assisting with multiple complex audit activities initiated by CMS / States. In this position, the Advisor will work closely with various Government / State auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business.
This position needs to be able to manage many audits at the same time with short turnaround times.
The Advisor will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations, formulary, and accumulation tracking in order to review and respond to all the auditors questions in a short window of time.
This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.
As an Advisor of Client Audit, you will be responsible for the following:
* Work directly with the government auditors, the client and all the internal business areas involved in the audit
* Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities
* Have a working knowledge base of Medicare Part D and the regulations
* Work independently with limited direction from the Sr. Manager
* Coordinate, manage, track the audits from start to closure
* Review and researching all questions from the auditor and client
* Work through and resolve any alleged issues; working strategically and achieving results
* Respond back to the auditor / client
* Raise appropriate at risk items to the Sr. Manager timely
* Documenting correspondence with internal partners, clients, and auditors
* Tracking all audit progress to ensure that all deliverables are provided by due dates
The ideal candidate will possess the following:
* Understanding of pharmacy claim adjudication
* Understanding of pharmacy manufacturer rebates
* Ability to actively seek new ways to grow and be challenged
* Critical thinking which translates into strategic actions
* Easily adapting to change
* Excellent verbal and written communications skills
* Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion. A working contributor responsible for each projects success.
* Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must. Strong tolerance for ambiguity and stress
* Strong ability to maintain attention to detail and organizational skills.
* Strong ability to hold oneself and others accountable for mitigating risk and achieving results
Required Qualifications
-Minimum 5 years of prior relevant experience in audit, project management, or financial advisory role
Preferred Qualifications
-Proficiency in Microsoft Word, Excel, PowerPoint
-PBM experience is also desired
-Knowledge of DBA/SQL and/or SAS
-Minimum 3 years pharmacy claim experience
-CPA, CIA or MBA preferred
Education
BS/BA required or high school diploma/GED and equivalent years of education and experience.
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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