Pharmacy Management AnalystBookmark This
DescriptionJob Category:Business Analyst
Clinical Licensure Required :Pharmacy Technician
Job Type:Full Time Position Summary:
CVS Caremark is looking for a professional CPhT with pharmacy experience and pharmacy compliance/audit background. This position will interpret a variety of pharmacy situations to provide feedback on pharmacy compliance. This candidate is also responsible for the review of pharmacy claims submitted through the CVS Caremark claims processing systems. Purpose of the review is to identify and rectify claim inaccuracies that would result in client overpayment. Position is an integral part of the pharmacy claims audit process and requires a detail-oriented and organized candidate. Candidate is responsible for contacting the pharmacy for proper documentation and educating on proper claims submission. Position maintains and provides feedback for a client-focused audit program and is hands-on in the claim correction process. Ability to prioritize, self-manage, and adhere to state/federal regulations is key.
Knowledge of pharmacy operations and strong computer and analytical skills are required. This position is responsible for monitoring pharmacy audit functions, developing / writing / teaching Policies & Procedures, facilitating learning for new hires, maintaining communications with other departments, and other ad hoc duties related to audit activities.
This position will have client and pharmacy facing requiring excellent communication skills. Required Qualifications:
3+ years of applicable experience required In-depth knowledge of pharmaceutical nomenclature, medications, and normal medication dosage ranges In-depth knowledge of PBM processing, Pharmacy Audit, and pharmacy operations Excellent time management skills and ability to maintain multiple high-priority tasks Excellent communication skills Ability to handle confrontational situations with a professional demeanor Computer knowledge - proficient with MS Office, Excel, Access, claims research and adjudication systems Pharmacy experience in retail, specialty, or PBM is required Bachelors Degree required Bilingual skills considered a plus Preferred Qualifications:
5+ years pharmacy experience Advanced degree Education:
Bachelor's degree Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.