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Position Summary
CVS Health is currently looking for a dynamic individual to join our team in an Sr. Analyst role. This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking, reviewing, researching and assisting with multiple complex audit activities initiated by CMS / States. In this position, the Sr. Analyst will work closely with multiple clients and various Government / State auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business. This position needs to be able to manage many audits at the same time with short turnaround times. The Sr. Analyst will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations, formulary, and accumulation tracking in order to review and respond to all the auditor’s questions in a short window of time. This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.
As a Sr. Analyst of Client Audit, you will be responsible for the following:
Work directly with the government auditors, the client and all the internal business areas involved in the audit
Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities
Work independently with limited direction from the Director
Coordinate, manage, track the audits from start to closure
Review and researching all questions from the auditor and client
Work through and resolve any alleged issues; working strategically and achieving results
Respond back to the auditor / client
Raise appropriate at risk items to the Director timely
Documenting correspondence with internal partners, clients, and auditors
Tracking all audit progress to ensure that all deliverables are provided by due dates
The ideal candidate will possess the following:
Understanding of pharmacy claim adjudication
Understanding of pharmacy manufacturer rebates
Ability to actively seek new ways to grow and be challenged
Critical thinking which translates into strategic actions
Easily adapting to change
Excellent verbal and written communications skills
Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion. A working contributor responsible for each project’s success.
Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must. Strong tolerance for ambiguity and stress
Strong ability to maintain attention to detail and organizational skills.
Strong ability to hold oneself and others accountable for mitigating risk and achieving results.
Required Qualifications
3+ years of prior relevant experience in audit and/or project management
Preferred Qualifications
Project management experience.
Proficiency in Microsoft Word, Excel, PowerPoint.
PBM experience.
CPA, CIA, or MBA
Education
BS/BA required or equivalent years of education and experience
Pay Range
The typical pay range for this role is:
$46,988.00 - $102,000.00This 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.