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AUDIT AND TESTING ADVISOR
Are you an innovator self starter? Do you want to make a difference? Are you in search of a challenge? If you feel this describes you, please read about our company and position below! CVS Health is an American retail pharmacy and health care company headquartered in Woonsocket, Rhode Island. CVS Health has numerous successes and accomplishments. We are the #7 revenue company on the Fortune 500 list. We have over 9700 retail locations throughout the US, Puerto Rico and Brazil and employee over 250K employees. We are a creative company that is trying to reinvent pharmacy to help people on their path to better health.
The Advisor is part a team responsible for the department’s audit and testing activities, for all assigned programs for Med D, Medicaid, and commercial products. These products include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill, Vaccine and Provisional Supply. You will deliver a consistent and effective program for developing the team's support of CMS and Audits. You will also provide confirmation of Welcome Season readiness through a set of robust, comprehensive testing plans.
In support of CMS program audits, you will work with your colleagues to gather pertinent information in advance of audits and adequately communicate implications to ensure a successful audit experience for our clients. Your ability to research claims, read benefit setup in RxClaim, and articulate risks or concerns is important.
As part of the Medicare Service Program you will be part of a creative and daring initiative aimed at transforming health care and pharmacy incorporating new information technologies and channels. We are looking for someone that has drive and can work cohesively with their colleague
ADDITIONAL RESPONSIBILITIES INCLUDE:
1. You will lead to close the deliverables resulting from audit activities in a timely manner. (Deliverables may include: corrective action plans to clients, CMS and other invested parties)
2. There may be opportunity to present claims in RxClaim via live webinars with CMS and clients
3. You will be able inspire change and drive cross-functional alignment by demonstrating our core values of teamwork and accountability
4. You will conduct year round quality assurance testing
5. You will need to incorporate new programs into all aspects of the testing program
6. You will have responsibility for validation of functionality of these new programs and will need to take any corrective actions.
2. 3+ years in a role managing regulatory requirements or interfacing with regulatory agencies
2. Experience with Medicare Part D or other government programs
3. Familiarity with CMS program audit processes and requirements
4. Expertise with MS Visio, Project, and SharePoint
5. Program or project management certification