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Job Title :
Advisor, Audit and Testing
Job ID :
Location :
AZ - Scottsdale, IL - Northbrook, RI - Cumberland, TX - Irving
Street Address :
9501 E Shea Blvd
Category :
Account Management
Description :
Job Description

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

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.

Required Qualifications
1. 5+ years of Pharmacy Benefit Management, Medicare Part D or Managed Care experience.

2. 3+ years in a role managing regulatory requirements or interfacing with regulatory agencies

Preferred Qualifications
1. Excellent communication, documentation, and problem-solving abilities

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

Bachelor's degree is required; equivalent work experience may substitute .

Business Overview
CVS Health, 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.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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Our culture

CVS Health core values of Innovation, Collaboration, Caring, Integrity, and Accountability not only support our purpose of helping people on their path to better health for our customers and patients, but they also apply to how we support our more than 250,000 colleagues. You will find our culture at CVS Health, and our leaders encourage personal and professional growth.

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