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Auditor, Pharmacy

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POST DATE 9/10/2016
END DATE 10/14/2016

Cotiviti USA, LLC Blue Bell, PA

Blue Bell, PA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree



Cotiviti Healthcare is the payment accuracy expert! We work with healthcare organizations to recover money, improve processes, strengthen relationships and maximize their value. We are a fast growing and highly successful payment accuracy firm with a long history of success. As we continue to grow, we are seeking experienced Pharmacy Auditors to join our team. This is a great opportunity to join a well-established company with competitive pay, opportunities to develop professionally and excellent benefits.

As a successful Pharmacy Auditor you will identify, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on your industry experience, regulatory research, and your ability to analyze medical claim data to discover incorrect payments. You will be responsible for analyzing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. You will assist in the identification, validation and documentation of moderate to more complex recovery projects. You will also be responsible for executing more independent projects assigned by your Operations Manager. If you are successful at thinking outside of the box , very analytical and love problem/puzzle solving complex medical claims, then look no further, review the position and requirements below and apply now!

Other responsibilities include:

* Utilizing healthcare experience to perform audit recovery procedures

* Identifying and validating incorrect claim payments

* Identifying and defining issues, developing criteria, reviewing and analyzing contracts and Health Plan reimbursement regulations

* Entering and documenting the incorrect payment issue into Cotiviti s systems accurately and in accordance with standard procedures

* Updating and developing new and current audit recovery reports, developing and running custom queries

* Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings


As a Pharmacy Auditor you must have a passion for solving complex medical claim reimbursement problems. You must be an independent thinker with a great attention to detail. You must be a self-disciplined team player who enjoys working in a collaborative environment. Qualified candidates have the ability to multitask, set priorities and meet deadlines.

What we re looking for:

* Bachelor s Degree preferred

* 2+ year s knowledge of healthcare related experience required (pharmacy billing, direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician claims, data analytics experience)

* Certified Professional / Hospital Coder Certification (CCS, CPC, CPC-H, CCS-P, CCRC, CCS-A, RHIA, RHIT ) preferred

* Prior claims auditing or consulting experience desirable in either a provider or payer environment

* Excellent communication skills both oral and written

* Strong interpersonal skills that will support collaborative team work

* Microsoft Office Proficient: Word and Excel; Access highly preferred

Our most important resource at Cotiviti is our dedicated staff of professionals. Joining the Cotiviti team means being welcomed into a collaborative, team-oriented environment. Our open and supportive culture encourages employee contributions that enable individual success and professional development. Our team thrives on a passion for success and creative independence.

* We are an Equal Opportunity Employer.

* Please view Equal Employment Opportunity Posters provided by OFCCP here.

* Cotiviti is an Equal Opportunity Employer. The Company provides equal employment opportunities to all applicants for employment without regard to gender, sexual orientation or preference, gender identity or expression, race, color, religion, national origin, ethnicity, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, mental or physical disability, veteran status or any other characteristic protected by federal, state or local law, ordinance or regulation..

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here.