Advisor - Client Audit - WORK FROM HOME FLEXIBLE
Remote or Scottsdale, AZ
CVS Health is currently looking for a dynamic individual to join our team in an Advisor role. In this client facing project management role, you will be responsible for coordinating, managing and assisting with audits and using broad and deep system set-up and adjudication knowledge, to develop complex queries to assist in the analysis. In this position you will work closely with various government auditors, 3rd party consultants and auditors, client account teams, legal and trade areas to ensure the completion of client requested audits with consistency and minimal disruption to the business.
Additionally, you will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process and to improve, develop and deliver on automation projects and complex analyses specifically related to audit deliverables. This position will also be expected to be analytical, able to understand regulation and identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions. This includes having an extensive knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations and accumulation tracking in order to review and respond to all the auditor's 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 a senior 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 deep knowledge base of Medicaid and Exchange regulations, as well as having some knowledge around Med D
* 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 resolving any alleged issues; working strategically and achieving results
* Work with the right business leaders to ensure responses are accurate and senior leaders are aware of any issues in accordance with regulatory timelines
* Respond back to the auditor / client
* Understand the intricacies of claim adjudication in order to answer questions related to the various claim testing sections, answering their questions correctly and confidently
* Identify process enhancements, as well as any gaps in controls within the business areas being audited
* Raise the appropriate items to senior leaders and doing so 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:
* A deep understanding of pharmacy claim adjudication
* 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 and experience communicating/presenting with all levels of leadership
* 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 project's 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.
* Team building skills that effectively influence and engage others in issue resolution-demonstrates pro-activeness looking out for the success of the team and CVS Health.
* Solves complex problems; takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
* Uses best practices and knowledge of internal or external business issues to improve products or services
* Strong ability to hold oneself and others accountable for mitigating risk and achieving results.
5+ years of prior experience in audit, project management, financial advisory or account management role
4+ years pharmacy claim experience
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
* If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
* If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
* Medicaid operational experience
* Internal or external audit experience
* Demonstrated excellent verbal and written communications skills.
* Proficiency in Microsoft Word, Excel, PowerPoint
BS/BA required or equivalent years of education and experience
CPA, CIA or MBA preferred.
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.
$55k-101k yearly est.