Quality Review and Pharmacy Technician Audit Lead Analyst - Express Scripts - Re
• **Location: Candidate must be located in the Minneapolis-Saint Paul metro area and must be willing to travel for pharmacy audits up to 50% of the time.***
POSITION SUMMARY:
The Quality Review and Pharmacy Technician Audit Lead Analyst is responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. They will complete audits in order to correct risks identified and present findings to the Sr Audit Manager. They may participate in third party audits and work collaboratively with cross functional partners to complete research needed and provide background knowledge needed to interpret audit scope. As a Staff Auditor, this position may act as a resource for less experienced team members and work on special projects as needed. This role will function as support of the Sr. Manager- Audit on some escalated issues and projects.
ESSENTIAL FUNCTIONS:
• Perform efficient and effective 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.
• Utilize personal knowledge of medications and available tools including the Enterprise Data Warehouse (EDW), Access, Excel, etc., identify pharmacies and claims representing audit risks and develop an audit plan, utilizing appropriate audit techniques, to efficiently and effectively address those risks.
• Develop and produce reports as required to meet needs of department management, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues.
• Prepare for and participate in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed audits, etc., for assigned clients.
• Perform special projects as assigned.
• 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.
• Assist with post audit as required by management.
IDEAL CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING:
• Bachelor's Degree or equivalent work experience preferred
• At least 2+ years of pharmacy technician experience in a retail, long term care, specialty, mail order or similar pharmacy setting or equivalent education.
• Certified Pharmacy Technician (CPhT) preferred.
• Proficient in database and spreadsheet applications, ie: Microsoft Excel, Access, Word.
• Excellent organizational, interpersonal, and communication skills.
• Ability to work well with all levels of internal and external contacts.
• Ability to handle sensitive or confidential information is critical.
• Ability to work with minimum management oversight while performing audits.
• Ability to work a flexible schedule to accommodate project deadlines.
• Ability and willingness to travel up to 50%. Reliable transportation for local travel for field audits within the Minneapolis-Saint Paul metro area
• Valid Driver's license required.
ABOUT THE DEPARTMENT:
The Pharmacy Operations Group is crucial to achieving our mission of helping to achieve a more sustainable health care system and better health for all. Members of this team are on the front line every day – interacting with patients, strategizing on improvements and efficiencies, and processing more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 67,200 - 112,000 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. 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: [email protected] for support. Do not email [email protected] 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.
Apply Now
Apply Now
POSITION SUMMARY:
The Quality Review and Pharmacy Technician Audit Lead Analyst is responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. They will complete audits in order to correct risks identified and present findings to the Sr Audit Manager. They may participate in third party audits and work collaboratively with cross functional partners to complete research needed and provide background knowledge needed to interpret audit scope. As a Staff Auditor, this position may act as a resource for less experienced team members and work on special projects as needed. This role will function as support of the Sr. Manager- Audit on some escalated issues and projects.
ESSENTIAL FUNCTIONS:
• Perform efficient and effective 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.
• Utilize personal knowledge of medications and available tools including the Enterprise Data Warehouse (EDW), Access, Excel, etc., identify pharmacies and claims representing audit risks and develop an audit plan, utilizing appropriate audit techniques, to efficiently and effectively address those risks.
• Develop and produce reports as required to meet needs of department management, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues.
• Prepare for and participate in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed audits, etc., for assigned clients.
• Perform special projects as assigned.
• 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.
• Assist with post audit as required by management.
IDEAL CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING:
• Bachelor's Degree or equivalent work experience preferred
• At least 2+ years of pharmacy technician experience in a retail, long term care, specialty, mail order or similar pharmacy setting or equivalent education.
• Certified Pharmacy Technician (CPhT) preferred.
• Proficient in database and spreadsheet applications, ie: Microsoft Excel, Access, Word.
• Excellent organizational, interpersonal, and communication skills.
• Ability to work well with all levels of internal and external contacts.
• Ability to handle sensitive or confidential information is critical.
• Ability to work with minimum management oversight while performing audits.
• Ability to work a flexible schedule to accommodate project deadlines.
• Ability and willingness to travel up to 50%. Reliable transportation for local travel for field audits within the Minneapolis-Saint Paul metro area
• Valid Driver's license required.
ABOUT THE DEPARTMENT:
The Pharmacy Operations Group is crucial to achieving our mission of helping to achieve a more sustainable health care system and better health for all. Members of this team are on the front line every day – interacting with patients, strategizing on improvements and efficiencies, and processing more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 67,200 - 112,000 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. 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: [email protected] for support. Do not email [email protected] 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.
Apply Now
Apply Now