Manager – Remote Jobs Arizona

Job Type: Manager from home
Location: Arizona work from home
Company: CVS Health

The manager position at CVS Health is presently open for a motivated person to join our team. You will be employing extensive and in-depth knowledge of system setup and adjudication in this client-facing project management role as you coordinate, manage, and help with audits. To ensure that government audits are completed consistently and with the least possible disturbance to the business, you will collaborate closely in this role with various government auditors, 3rd party consultants and auditors, client account teams, legal and trade areas.

Responsibilities:

You will also be in charge of ensuring that any exceptions found throughout the audit process are resolved promptly and satisfactorily as well as enhancing, developing, and delivering automation projects and complicated analytics directly relevant to audit deliverables. This position will also require analytical skills, the ability to comprehend regulations, and the ability to see process improvement possibilities in order to minimize or completely eliminate the risk of future client audit exceptions. In order to examine and react to all the auditor questions in a limited amount of time, this entails having a thorough understanding of the concepts of pharmacy claim adjudication, including but not limited to benefit setup, prior authorizations, claims payment, and pharmacy contracting. In addition, this individual will be expected to find ways to improve processes in order to decrease or completely eliminate the risk of future audit exceptions, as well as to make sure that any concerns or problems are brought up to top management right away. Researching claim-specific queries must be able to analytically discover, track, and support business owners in process enhancement opportunities to reduce risks.

The following are the duties you will have as a Manager of Client Audit:

• Work closely with the customer, the internal business auditing divisions, and the government auditors
• The job needs to be able to handle all of the competing demands because there is no room for error with government audits, which occur in waves across multiple clients at the same time.
• Possess thorough knowledge of Medicaid and Exchange laws, as well as some understanding of Med D
• Work autonomously with little guidance from the Sr Manager
• Coordinate, oversee, and keep track of the audits from beginning to end.
• Examine and investigate each query from the auditor and the customer.
• Work through and resolve any stated problems; use strategy to produce results.
• Ensure replies are accurate and senior management are informed of any concerns in compliance with regulatory timelines by working with the appropriate business leaders.
• Return the auditor’s or client’s message
• Understanding the complexities of claim adjudication will help you respond correctly and confidently to questions relating to the various claim testing parts.
• Determine any process improvements and any control gaps in the audited business areas.
• Raise the pertinent issues with senior leaders and do so promptly.
• Keeping track of communications with clients, internal partners, and auditors
• Keeping track of every audit’s development to make sure all deliverables are delivered before the deadline

Pay Scale

The usual pay scale for this position is as follows: 60,300 minimum; 130,000 maximum

Please remember that this range represents the salary range for every position in the job grade that this position belongs to. The location is just one of several variables that will be considered when determining the actual compensation offer.

Requirements:

These qualities will characterize the perfect applicant:

• A thorough knowledge of pharmacy claim resolution
• The capacity to actively look for new opportunities to learn and progress
• Critical thought that leads to tactical action
• Able to quickly adjust to change
• Excellent written and verbal communication abilities and expertise interacting and presenting to executives at all levels
• Strong project management abilities, including the capacity to adapt to and cope with challenging situations that may be unanticipated, while effectively managing a number of projects from inception to completion. an active participant accountable for each project’s success.
• It is essential to have the ability to communicate clearly with clients and government auditors under pressure when conducting an audit.
• Strong ability to keep attention to detail and organizational abilities. Strong tolerance for ambiguity and stress.
• Teamwork skills that successfully persuade and include others in problem-solving situations show initiative and concern for the success of the group and CVS Health.
• Applying judgment based on the study of many sources of information, solves difficult challenges, and uses best practices and understanding of internal or external business issues to improve products or services
• Excellent capacity to hold oneself and others responsible for risk mitigation and results.

Required Credentials

• Previously relevant experience in an audit, project management, or financial advice function for at least 5 years
• Experience processing pharmacy claims for three years or more

Preferred Qualifications

• Operational Medicaid experience
• Expertise with internal or external audits
• Strong verbal and written communication skills were on display.
• A working knowledge of Microsoft Word, Excel, and PowerPoint PBM Also sought is experience.
• Preferably a CPA, CIA, or MBA.

Education

Requires a bachelor’s degree or comparable job experience.