Quality Review and Audit Senior Analyst (Desk Auditor) - Express Scripts - Hybrid - The Cigna Group
Bloomfield, CT
About the Job
POSITION SUMMARY:
Responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. Complete investigational audits in order to correct risks identified and present findings to Sr. Audit Manager. Thoroughly read, interpret and fully understand the key elements of each specific contract.
ESSENTIAL FUNCTIONS:
+ Utilize current programs and analytical procedures and existing tools, including Access, Excel, etc., while utilizing personal knowledge of medications to identify clients, members and claims representing financial risks.
+ Responsibility for reprocessing claims identified that have been previously processed.
+ Perform efficient and effective investigatory audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals.
+ Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective opinion on the accuracy and legitimacy of claims audited.
+ Analyze audit findings to determine validity of any identified discrepancies.
+ Full responsibility for handling/researching complex issues identified during an audit.
+ Prepare formal and thorough written reports providing opinions on the findings of the audits performed, client impact, ESI risk, etc. as needed.
+ Submit findings to Sr. Auditors and Sr. Audit Manager for review.
+ Responsibility for providing ad hoc reports to key business owners.
+ Special projects as assigned and as needed.
IDEAL CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING:
+ Bachelor’s degree in related field or 5+ years of related experience.
+ Certified Pharmacy Technician.
+ Highly proficient in data warehousing, database and spreadsheet applications.
+ Proficiency in CuraScript proprietary systems preferred.
+ Excellent organizational and interpersonal skills.
+ Excellent verbal and written communication skills.
+ Excellent interpersonal skills and the ability to effectively communicate with all levels of management.
+ Ability to work cross functional departments to research and resolve issues using innovative solutions.
+ Demonstrated ability to meet multiple deadlines and manage a dynamic workload.
+ Ability to work a flexible schedule to accommodate project deadlines.
+ Ability to present audit findings and recommendations to business owners.
+ Demonstrated analytical and problem-solving skills.
+ Ability to use judgment in analysis of findings and ability to outline recommendations for specific outcomes.
+ Ability to handle sensitive or confidential information is critical to success of the role.
ABOUT THE DEPARTMENT:
Our Pharma & Retail Relations team plays a key role in keeping us at the forefront of the health care evolution. Team members oversee partnerships with Express Scripts’ key supplier groups, including brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers. Successfully maintaining these relationships allows our 100 million patients access to the medicine they need at a price they can afford.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 56,600 - 94,300 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances._
Responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. Complete investigational audits in order to correct risks identified and present findings to Sr. Audit Manager. Thoroughly read, interpret and fully understand the key elements of each specific contract.
ESSENTIAL FUNCTIONS:
+ Utilize current programs and analytical procedures and existing tools, including Access, Excel, etc., while utilizing personal knowledge of medications to identify clients, members and claims representing financial risks.
+ Responsibility for reprocessing claims identified that have been previously processed.
+ Perform efficient and effective investigatory audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals.
+ Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective opinion on the accuracy and legitimacy of claims audited.
+ Analyze audit findings to determine validity of any identified discrepancies.
+ Full responsibility for handling/researching complex issues identified during an audit.
+ Prepare formal and thorough written reports providing opinions on the findings of the audits performed, client impact, ESI risk, etc. as needed.
+ Submit findings to Sr. Auditors and Sr. Audit Manager for review.
+ Responsibility for providing ad hoc reports to key business owners.
+ Special projects as assigned and as needed.
IDEAL CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING:
+ Bachelor’s degree in related field or 5+ years of related experience.
+ Certified Pharmacy Technician.
+ Highly proficient in data warehousing, database and spreadsheet applications.
+ Proficiency in CuraScript proprietary systems preferred.
+ Excellent organizational and interpersonal skills.
+ Excellent verbal and written communication skills.
+ Excellent interpersonal skills and the ability to effectively communicate with all levels of management.
+ Ability to work cross functional departments to research and resolve issues using innovative solutions.
+ Demonstrated ability to meet multiple deadlines and manage a dynamic workload.
+ Ability to work a flexible schedule to accommodate project deadlines.
+ Ability to present audit findings and recommendations to business owners.
+ Demonstrated analytical and problem-solving skills.
+ Ability to use judgment in analysis of findings and ability to outline recommendations for specific outcomes.
+ Ability to handle sensitive or confidential information is critical to success of the role.
ABOUT THE DEPARTMENT:
Our Pharma & Retail Relations team plays a key role in keeping us at the forefront of the health care evolution. Team members oversee partnerships with Express Scripts’ key supplier groups, including brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers. Successfully maintaining these relationships allows our 100 million patients access to the medicine they need at a price they can afford.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 56,600 - 94,300 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances._
Source : The Cigna Group
