Job Description

Job Description
CVS Health is currently looking for a dynamic individual to join our team in an Advisor role!!! This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking, reviewing, researching and assisting with multiple complex Anthem (IngenioRx) audit activities initiated by CMS / States. You will work closely with Anthem (IngenioRx), various Government / State auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business. This position needs to be able to lead many audits at the same time with short turnaround times. The Advisor will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations, formulary, and accumulation tracking in order to review and respond to all the auditors 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.
Responsibilities Include:
Have a working knowledge base of Medicare Part D and the regulations
Coordinate, manage, track the audits from start to closure
Work through and resolve any alleged issues; working strategically and achieving results
Documenting correspondence with internal partners, clients, and auditors
Tracking all audit progress to ensure that all deliverables are provided by due dates
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 projects success.

Required Qualifications
5 years experience in audit, project management, or financial advisory role
3 years pharmacy claim experience

Preferred Qualifications
Project management experience
Microsoft Office
PBM experience
CPA, CIA or MBA preferred

Education
BS/BA required

Business Overview
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.