What are the responsibilities and job description for the Pharmacy Technician Auditor - Express Scripts - Remote position at Cigna?
Job Description Summary Provides advanced professional input to complex Quality Assurance / Audit assignments / projects to identify pharmacy audit risks.
Works autonomously, only requiring "expert" level technical support from others.
Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Quality Review and Audit.
Using independent judgement and discretion, may recommend changes in processing procedures. Job Description The Pharmacy Technician Auditor is primarily responsible for using analytical skills and audit tools to identify network pharmacy audit risks and develop / execute audit plans and scope of procedures determined necessary to address those risks.
Under a moderate level of guidance, this position performs complex on-site network pharmacy audits to correct risks identified, protect client assets, and present findings to key internal and external stakeholders.
This role must adhere to department policies, state and federal requirements and client contractual requirements . ESSENTIAL FUNCTIONS
- Perform efficient and effective network pharmacy claims 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 assessment of the accuracy and legitimacy of claims audited.
Has full responsibility for handling / researching complex issues identified during an audit
Providing updates to management on current status of audits including any escalated issues.
Analysis includes, pricing, prior authorization, eligibility, plan set-up, financial and performance guarantees, and adherence to state specific laws.
Coordinates with cross-functional departments to obtain appropriate resolution to identified issues.
Tracks status and serves as main contact for pharmacies during all audits
Mentor less experienced team members to improve their understanding and skills by ensuring they are familiar with resource materials including manuals and systems.
Responsible for the training of new associate auditors on departmental processes. QUALIFICATIONS
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.
Salary : $67,200 - $112,000
