Pharmacy Credentialing & Audit Analyst - AZ Residents Only

Bring your heart to CVS Health.
Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health.
This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.
Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose.
We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryThe Pharmacy Quality Control Analyst position is responsible for the timely and accurate delivery of key department, company, and client driven deliverables.
The primary areas of responsibility include standards conformance, audit sampling, and regulatory compliance support.
This position is accountable for and performs an integral role in the enforcement and administration of quality control compliance for pharmacy provider enrollment; pharmacy provider credentialing and contract audit sampling fulfillment; and legal-regulatory requests for pharmacy contracting information.
Duties of the Analyst require a high degree of critical independent thinking, a keen sense of judgement with the ability to make decisions efficiently.
Day to day functions require a strong focus with mental endurance and the flexibility to adapt to a fast-paced work environment with limited supervision.
The Analyst must possess the sustainability and aptitude to create new tools and reports while maintaining an in depth understanding of the PBM and enterprise pharmacy environment.
The Analyst interfaces with and manages communication with a multi-level audience.Detailed Responsibilities:
Quality Control Pharmacy Provider Network - This position is responsible for ensuring pharmacy enrollment compliance with respect to SOX internal controls, SSAE-16 (SOC1) Reporting, and URAC accreditation.
This position is accountable for the detection and prevention of pharmacy enrollment errors and omissions.
Functions of this role include validation and verification of documentation compliance and data accuracy of pharmacy enrollment to mitigate negative financial business impacts and avoid service warranties, client issued corrective action plans, and to promote successful pharmacy network enrollment audits.
Ongoing value-added activities center around continual development and enhancement of the quality review processes and tools for increased control and efficiency; SME support and analysis for ad hoc projects; interface with internal partners and lead cross functional task groups.Pharmacy Provider Credentialing & Contract Audit fulfillment - responsible for the assessment and compilation of audit sampling documentation.
This includes accountability for the accurate interpretation of the audit scope and requirements which is critical to safeguard confidential and proprietary documents, prevent inclusion of ancillary non- value- added documentation, ensure audit requirements are in compliance with company policy and avoid client issued corrective action plan.
Legal & Regulatory Requests for Information (RFI's) related to Pharmacy Credentialing & Contracting - accountable for the accurate assessment and scrutiny of the request to ensure that the correct documentation is supplied.
Accurate interpretation of the request and the ability to assess the business need are critical to avoid documentation errors or omissions for litigation, or regulatory investigations (e.g.
FBI, Federal & State OIG/OAG, DOH, MEDIC, etc.).
Required Qualifications+ Previous accounting or auditing experience, detail oriented in reviewing documentation+ Strong interpersonal skills, written and verbal communication skills+ Strong knowledge of mainframe applications for pharmacy enrollment and claims processing for Recap &, RxClaim)+ Proficient in Microsoft Office - Excel, Word, and Access.
Ability to perform detailed QC functions in a speedy, efficient, and accurate manner is critical.+ Ability to work independently and as a team, manage large workload, multiple deliverables, and projects simultaneously.Preferred QualificationsAdobeEducationAssociate or Bachelor Degree (or commiserate experience)Pay RangeThe typical pay range for this role is:
$40,600.00 - $83,400.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.
The Company offers a full range of medical, dental, and vision benefits.
Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.
The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.
CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
As for time off, Company employees enjoy Paid Time Off ('PTO') or vacation pay, as well as paid holidays throughout the calendar year.
Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits We anticipate the application window for this opening will close on:
06/30/2024We are an equal opportunity and affirmative action employer.
We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.