Pharmacy Internal Auditor
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Tampa, FL, USA, Richmond, VA, USA, St. Louis, MO, USA, Mason, OH, USA, Norfolk, VA, USA, Atlanta, GA, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level |
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.
Responsibilities
- 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with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops, and recommends process improvements and solutions.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.
Preferred Qualifications
- 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.