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Pharmacy Internal Auditor
2 months ago
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
A proud member of the Elevance Health family of companies, CarelonRx leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.
The Pharmacy Internal Auditor is responsible for driving service quality excellence by evaluating the quality of services and interactions provided by CarleonRx pharmacies. Included are all pharmacy processes and processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.
How you will make an impact:
- Assists higher level auditor/lead on field work as assigned and acts as auditor in charge on small and less complex audits.
- Participates in pre and post implementation audits of pharmacy operational processes, claims processing and payment, member and provider inquiries, enrollment & billing transactions, and the corrective action plan process.
- Demonstrates ability to audit multiple lines of business, multiple functions, and multiple systems.
- Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.
- Works closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops, and recommends process improvements and solutions.
- Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.
- Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.
- Travel to sites to oversee the implementation and follow up of new and enhanced processes and programs; or to perform audits.
Minimum Requirements:
- Requires a BS/BA; a minimum of 3 years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1-year related experience in a quality audit capacity; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Experience in a high volume, mail order, or specialty pharmacy preferred.
- Ability to work independently and as part of a team.
- Demonstrated experience netting improvements from audits.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
