- Ability to travel 1-3 weeks each month to perform on-site audits.
- Support desk and/or daily audits for Capital Rx as needed when not performing on-site audits or support functions for these audits.
- Work with internal departments to further develop processes to improve the accuracy of high-risk claims selection that are recommended for outreach and/or audit.
- With support from claim scoring algorithms, select claims that will be audited in accordance with provider agreements and state law requirements.
- Provide insight and expertise to improve any processes related to audit functions and claim selection algorithms.
- Work with internal departments including Customer Care, Client Account Management, Clinical, Compliance, and Finance teams as needed on any pharmacy audit-related issues.
- Support investigations and refer providers to the Special Investigations Unit or Pharmacy Evaluation Committee in cases of suspected FWA.
- Perform various aspects of audits including reviewing claim data, sending audit notice to provider, follow-up outreach as needed, review of prescription information, submission of audit findings, appeal review, and submission of final findings.
- Review state/federal/local pharmacy laws and provider agreements as applicable in consultation with legal or regulatory teams as needed to ensure state and/or federal guideline adherence.
- Provide other assistance as assigned by the Provider Relations team.
- Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.
- Nationally Certified Pharmacy Technician (CPhT or similar equivalency)
- Bachelors degree preferred.
- 4+ years of experience in healthcare, audit, provider relations, pharmacy, or other relevant experience
- Intermediate level of proficiency with Microsoft Office products
- Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out tasks.
- Ability to work independently, track work/projects appropriately and remain on task.
- Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders.
- At least 1 year of PBM experience required.
-
Audit Analyst
2 weeks ago
Sumitomo Mitsui Banking Corporation New York, United StatesSMBC Group is a top-tier global financial group. Headquartered in Tokyo and with a 400-year history, SMBC Group offers a diverse range of financial services, including banking, leasing, securities, credit cards, and consumer finance. The Group has more than 130 offices and 80,000 ...
-
Sr. Analyst, Audit
1 week ago
Warner Media, LLC New York, United StatesWelcome to Warner Bros. Discovery the stuff dreams are made of. Who We Are When we say, the stuff dreams are made of, were not just referring to the world of wizards, dragons and superheroes, or even to the wonders of Planet Earth. Behind WBDs Audit, Analyst, Advisor, Accounting, ...
-
Senior Analyst, IT Audit
1 week ago
Scotiabank New York, United StatesSenior Analyst, IT Audit · Requisition ID: · Salary Range: 67, ,200.00 · Please note that the Salary Range shown is a guideline only. Salary offered may vary based on factors, including, but not limited to, the successful candidates relevant knowledge, skills, and experience. ...
-
Pharmacy Audit Analyst
1 week ago
Capital Rx New York, United StatesLocation: Remote (For Non-Local) or Hybrid (Local to NYC area) · Position Responsibilities: · Ability to travel 1-3 weeks each month to perform on-site audits. · Support desk and/or daily audits for Capital Rx as needed when not performing on-site audits or support functions fo ...
-
Senior Analyst, IT Audit
3 weeks ago
Scotiabank New York, United StatesRequisition ID: · Salary Range: 67, ,200.00 · Please note that the Salary Range shown is a guideline only. Salary offered may vary based on factors, including, but not limited to, the successful candidate's relevant knowledge, skills, and experience. · Join a purpose driven wi ...
-
Sr. Analyst, Audit
2 weeks ago
WARNERMEDIA New York, United States Full timeWelcome to Warner Bros. Discovery... the stuff dreams are made of. · Who We Are... · When we say, "the stuff dreams are made of," we're not just referring to the world of wizards, dragons and superheroes, or even to the wonders of Planet Earth. Behind WBD's vast portfolio of ico ...
-
Sr. Analyst, Audit
1 week ago
Warner Media Group New York, United StatesWelcome to Warner Bros. Discovery... the stuff dreams are made of. · Who We Are... · When we say, "the stuff dreams are made of," we're not just referring to the world of wizards, dragons and superheroes, or even to the wonders of Planet Earth. Behind WBD's vast portfolio of i ...
-
Audit Analyst
2 weeks ago
Into City Prep New York, United States Full timeOur client, a prestigious and expanding Private Equity firm based in New York, is seeking an Audit Analyst to join their dynamic and driven audit team. This role is an exceptional opportunity for an individual in the early stages of their Audit career aiming to transition into th ...
-
Audit Analyst
3 weeks ago
Royal Bank of Canada Jersey City, United States Full timeJob Summary · The Audit Analyst supports the US IA team in conducting audits to assess the effectiveness of US Finance and Corporate Treasury controls, accuracy of financial records, efficiency of operations, and compliance with governmental regulation.Job Description · What is t ...
-
Audit Analyst
2 weeks ago
Royal Bank of Canada Jersey City, United States Full timeCome Work with Us · At RBC, our culture is deeply supportive and rich in opportunity and reward. You will help our clients thrive and our communities prosper, empowered by a spirit of shared purpose. · Whether you're helping clients find new opportunities, developing new technolo ...
-
Citigroup Inc New York, United StatesThe Data Governance Foundation Lead Analyst is responsible for contributing to the directional strategy and assisting in creation and modification of Enterprise Data Governance Strategy, and/or Data Risk and Control Framework and Data Risk Taxonomy. The focus of this role may be ...
-
ECDO Data Audit and Quality Assurance Analyst
9 hours ago
00002 Citibank, N.A. New York, United States Full timeThe Data Governance Foundation Lead Analyst is responsible for contributing to the directional strategy and assisting in creation and modification of Enterprise Data Governance Strategy, and/or Data Risk and Control Framework and Data Risk Taxonomy. The focus of this role may be ...
-
freelance sales audit analyst
1 month ago
Solomon Page Fashion & Beauty New York, United States Freelance/ContractWe are looking for a Freelance Sales Audit Analyst for a top fashion company in New York City · Responsibilities: · Daily cash and credit card reconciliations · Assist with audits · Handle month-end closings · Prepare and book monthly credit card fees and expense accruals · Proce ...
-
Cardiac Device Auditing Analyst
19 hours ago
Cardiac RMS LLC New York, United States**Title**: CIED Auditing Analyst · **Location**:Remote · **Employment Type**:Full-Time · **Salary**:$71,000 - $80,000 · **Benefits**: Medical, Dental, and Vision (with company contribution), Paid Time Off, 401k · **This position requires CRAT certification upon hire, and IBHRE ce ...
-
Tax Senior Analyst, Audits
1 month ago
Authentic New York City, United States Full time· Forward to localhost with CLI · whcli forward --token=5d7958cd-4b5a-41d6-a347-9be9ed59158f Install whcli · generates free, unique URLs and e-mail addresses and lets you see everything that's sent there instantly. · Built-in integrations: · Google Sheets, Excel, Slack, Dropbox ...
-
Internal Audit Summer Analyst Program
3 weeks ago
NOMURA New York, United StatesRegion 1 · - Americas · Division 1 · - Corporate · Location 1 · - New York · Program type 1 · - Internship · Level 1 · - Analyst · Job description 1 · **Company Overview** · **Corporate Infrastructure Division** · Our Corporate Infrastructure is what underpins the success of the ...
-
Year end Audit Coordinator Analyst
3 weeks ago
PGMTEK Inc. New York, United StatesJob Description · It is the policy of ICBCFS to comply with federal and state laws and regulations, as well as United States Generally Accepted Accounting Principles (US GAAP). The Finance Department is responsible for adhering to and complying with fiscal and regulatory norms. ...
-
medical audit analyst
1 week ago
Montefiore Medical Center Tarrytown, United States Regular Full timeUnder general direction reviews and researches patient medical records in order to describe reason for admission/visit/care, treatment rendered \, surgical procedures performed and diagnoses at discharge. Identifies and documents reason for care, sequence of events, therapies, pr ...
-
Conflicts and Audit Letter Analyst
1 week ago
Considine Search Roseland, United StatesRoseland, NJ · Summary · The Conflicts and Audit Letter Analyst will be responsible for a variety of tasks, including the performance and generation of conflict of interest reports using internal and external databases and the review, analysis, and resolution of potential conflic ...
-
Senior Medical Audit Analyst
1 week ago
Montefiore Tarrytown, United StatesThe impact of the coding function on the reimbursement and cash flow of the medical center is considerable. Submission of quality data as required by State and National regulatory and accrediting bodies has major impact on MMC reputation and prominence in the health care industry ...
Pharmacy Audit Analyst - New York, United States - Capital Rx, Inc.
Description
Location:
Remote (For Non-Local) or Hybrid (Local to NYC area)
Position Responsibilities:
Required Qualifications:
Nothing in this position description restricts managements right to assign or reassign duties and responsibilities to this job at any time.
Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nations electronic healthcare infrastructure to improve drug price visibility and patient outcomes.
As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the companys cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices.
JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans.
Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table.
We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
