Express Scripts by Evernorth · 7 hours ago

Pharmacy Claims Auditor (12 Month Contract) - Express Scripts Canada

United States

Contract

Remote

Entry, Mid Level

$197K/yr - $328K/yr

2+ years exp

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Responsibilities

Perform claim verifications, desk and/or on-site audits

Communicate with providers to gather information for audits, to educate on claim submission practices and to respond to queries in regards to audit results

Assess provider documentation to ensure compliance with ESC’s provider agreement, benefit plan design and provincial legislation

Calculate the adjustments required to correct claim transactions

Prepare, coordinate and travel to conduct on-site audit at the provider’s location, and complete the post on-site audit activities

Compile and produce audit reports that are detailed and unbiased

Perform self and peer-review to ensure accuracy and quality of claim reviews

Track audit activity and summarize results of claim analysis and recoveries on a daily and/or monthly basis for department statistics for presentation to customers

Identify trends observed from claim reviews and provide recommendations for risk criteria changes and/or candidates for a desk or on-site audit.

Recommend incremental and continuous ideas that will increase ability to prevent and manage risk that will bring the most value to customers

Respond to internal and external customer questions professionally, timely and accurately

Other duties and responsibilities as assigned

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.

Retail pharmacy experiencePharmacy benefits knowledgePharmacy regulations knowledgePharmacy softwareAudit experienceR Ph.T. designation