CVS Health Hiring For Client Audit Manager at Arizona Full Time

CVS Health is currently looking for a dynamic individual to join our team in a Manager role. In this client facing project management role, you will be responsible for coordinating, managing and assisting with audits and using broad and deep system set-up and adjudication knowledge. In this position you will work closely with various government auditors, 3rd party consultants and auditors, client account teams, legal and trade areas to ensure the completion of government audits with consistency and minimal disruption to the business.

Additionally, you will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process and to improve, develop and deliver on automation projects and complex analyses specifically related to audit deliverables. This position will also be expected to be analytical, able to understand regulation and identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions. This includes having an extensive knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review and respond to all the auditor 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 Manager 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
• Have a deep knowledge base of Medicaid and Exchange regulations, as well as having some knowledge around Med D
• Work independently with limited direction from the Sr Manager
• Coordinate, manage, track the audits from start to closure
• Review and research all questions from the auditor and client
• Work through and resolving any alleged issues; working strategically and achieving results
• Work with the right business leaders to ensure responses are accurate and senior leaders are aware of any issues in accordance with regulatory timelines
• Respond back to the auditor / client
• Understand the intricacies of claim adjudication in order to answer questions related to the various claim testing sections, answering their questions correctly and confidently
• Identify process enhancements, as well as any gaps in controls within the business areas being audited
• Raise the appropriate items to senior leaders and doing so 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:

• A deep understanding of pharmacy claim adjudication
• 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 and experience communicating/presenting with all levels of leadership
• 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.
• Team building skills that effectively influence and engage others in issue resolution-demonstrates pro-activeness looking out for the success of the team and CVS Health.
• Solves complex problems; takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
• Uses best practices and knowledge of internal or external business issues to improve products or services
• Strong ability to hold oneself and others accountable for mitigating risk and achieving results.

Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 130,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
5 or more years of prior relevant experience in audit, project management, and/or financial advisory role

3 or more years of pharmacy claim experience

Preferred Qualifications

• Medicaid operational experience
• Internal or external audit experience
• Demonstrated excellent verbal and written communications skills.
• Proficiency in Microsoft Word, Excel, PowerPoint
• PBM Experience is also desired
• CPA, CIA or MBA preferred.

Education
Bachelor’s degree or equivalent work experience required

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.