At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary:
The Third Party Audit Analyst is a subject matter expert in the insurance industry and CVS/pharmacy accounts receivable processes for Federal and State Government, along with Commercial payers, paying for scripts dispensed at CVS/pharmacy Retail locations. The Analyst makes business decisions based upon analytics of Pharmacy Audits to reduce bad debt, eliminate legal risk, and ensure compliance to all federal/state requirements and CVS Health obligations.
The Third Party Audit Analyst will focus on Monthly reconciliation and write off's along with building and utilizing ADHOC reporting. This role will focus on performing analysis and root cause diagnosis on various Third Party Audit activities around the top audit bad debt drivers, payer/plan dynamics and month-end procedures. The Analyst will make recommendations for and implement process improvements with payers and/or CVS Health systems and operations. This function supports the goals of recognizing and controlling bad debt through process enhancements and focused efforts in the timely resolution of all audits.
Key Responsibilities:
- Reconciling 835 transactions against expected audit recoveries.
- Managing Month End processes.
- Build & run standardized audit reporting.
- Managing State Funded (Medicaid FFS) audit processes end-to-end.
- Assist in developing audit risk mitigation strategies.
Required Qualifications:
- 1+ years of MS Office Access & Excel experience.
Preferred Qualifications:
- 3+ year experience with RxConnect System.
- Excellent verbal and written communication skills and the ability to interact professionally with a diverse group – directors, managers, colleagues, and external entities.
- Proficiency with SQL.
- Independent problem solver with a strong desire to learn new skills.
- 1+ years of analytics experience.
- Preferred EST Time Zone
Education:
- Verifiable High School Diploma or GED required
- Bachelor’s Degree in a technical or business field preferred or relevant work experience
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$43,888.00 - $93,574.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 06/01/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.