Medicare Pharmacy Claims Auditor, CVS Health

Medicare Pharmacy Claims Auditor

CVS Health

Location:
United States, Phoenix

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

43888.00 - 85068.00 USD / Year

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Job Description:

This position is an opportunity to join CVS Caremark's Pharmacy Audit division administering Medicare Part-D Compliance Audit Programs. Responsibilities include reviewing pharmacy claims, conducting audits, and collaborating to develop solutions keeping CVS Health in compliance with CMS requirements.

Job Responsibility:

telephone outreaches to network pharmacies to verify claim information
transmission of audit requests to pharmacies
review of hard copy prescriptions to verify compliance with CMS requirements and CVS Health contractual requirements
review incoming documentation from pharmacies and input information into internal CVS Health audit systems
corresponding with network pharmacies to answer questions regarding Medicare Audit Programs
monitor assigned audit processes and report statuses on a regular basis
meeting with internal partners to develop and communicate business objectives

Requirements:

1+ year(s) combined experience in a PBM or pharmacy
familiarity with current CMS Medicare Part-D compliance regulations
advanced level of technical skillsets including Microsoft Excel, Microsoft Access, and SQL databases
PTCB certification

Nice to have:

5+ years combined experience in PBM or pharmacy
2+ years experience in PBM or pharmacy claim processing systems
bachelor's degree

What we offer:

affordable medical plan options
401(k) plan including matching company contributions
employee stock purchase plan
wellness screenings
tobacco cessation and weight management programs
confidential counseling
financial coaching
paid time off
flexible work schedules
family leave
dependent care resources
colleague assistance programs
tuition assistance
retiree medical access

Additional Information:

Job Posted:
August 27, 2025

Expiration:
September 29, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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