33 applicants

Company

IQVIA · 3 days ago

Pharmacy Integrity Auditor

Bridgewater, NJ

Full-time

Remote

Mid Level

$50K/yr - $54K/yr

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Responsibilities

Responsible for conducting pharmacy claims audits at the request of operations and management teams. May leverage health care providers, medical facilities, various billing portals, and contracting teams, as necessary.

Responsible for collaboration with pharmacy facilities to acquire and review documentation necessary for assessing and validating compliance of claims against program business rules.

Exercise independent judgment to determine appropriate corrective action of noncompliant claims, notify pharmacies of findings, and provide instructions on the appropriate corrective action. This can include potential reversal, refund, or reprocessing of claims.

Document all details pertaining to claims audits and provide a summary to appropriate management team members.

Provide interpretation and consultation to project teams on project specific guidelines/instructions and policies and procedures.

Evaluate applicable regulations/guidelines, customer requirements, Standard Operating Procedures (SOPs) and project specific guidelines/instructions to assist with planning, scheduling, conducting, reporting and closing internal audit activities, as time permits.

Self-starter able to carry out job responsibilities with minimal supervision.

Possess exceptional organizational skills.

Capable of recognizing operational challenges and collaborating with team to design solutions.

Requires the ability to handle multiple simultaneous tasks with various deadlines while prioritizing urgent requests.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Pharmacy claims auditsHIPAA certifiedCustomer care experienceAuditing experiencePharmacy Technician experienceMS Office applications

Required

High School diploma or equivalent

Previous experience working in a customer care environment

Excellent problem solving, telephone and communication skills

Good customer relationship skills

Ability to exercise independent judgment, appropriate discretion, and escalate to management as appropriate.

Ability to rapidly adapt to new technologies and assess their potential impact and usefulness in diverse areas within the company

Ability to work flexibly with the team to ensure timely delivery of service

Ability to produce high quality work under pressure and within tight timescales

An ability to work within tight deadlines and manage time effectively.

Strong team player with flexible attitude to work priorities.

Excellent computer skills (MS Office applications)

Preferred

HIPPA certified

Bachelor’s Degree Preferred

Ability to interpret Explanation of Benefits (EOB)

Previous auditing experience

Pharmacy Technician experience

Company

IQVIA

Glassdoor

3.9

IQVIA provides analytics, compliance, and management solutions to the life sciences industry.

Founded in 1982

Danbury, Connecticut, USA

10,001+ employees

https://www.iqvia.com

H1B Sponsorship

IQVIA has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (218)

2022 (199)

2021 (286)

2020 (197)