Posted in Pharmaceutical 30+ days ago.
Type: Full-Time
Location: Birmingham, Alabama
POSITION SUMMARY The Staff Field Auditor is primarily responsible for using analytical skills and audit tools to identify network pharmacy audit risks and develop/execute audit plans and scope of procedures determined necessary to address those risks. Under a moderate level of guidance, this position performs complex on-site network pharmacy audits in order to correct risks identified, protect client assets, and present findings to key internal and external stakeholders. The Staff Field Auditor will assist in mentoring and developing less experienced Audit Team Members. ESSENTIAL FUNCTIONS
Perform efficient and effective audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals. Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective assessment of the accuracy and legitimacy of claims audited.
Utilizing personal knowledge of medications and available tools including the Enterprise Data Warehouse (EDW), Access, Excel, etc., identify pharmacies and claims representing audit risks and develop an audit plan, utilizing appropriate audit techniques, to efficiently and effectively address those risks.
Develop and produce reports as required to meet needs of department management, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues.
Prepare for and participate in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed audits, etc., for assigned clients.
Perform special projects as assigned. Mentor less experienced team members to improve their understanding and skills by ensuring they are familiar with resource materials including manuals and systems. Responsible for the training of new associate auditors on departmental processes.
Assist with post audit as required by management. QUALIFICATIONS
This role is subject to the CMS (Centers for Medicare/Medicaid Services) COVID-19 vaccine mandate. Full vaccination is required, meaning that workers in this position must have received one dose of the Johnson & Johnson vaccine or two doses of an mRNA vaccine before the first day of work.
About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
Siemens Medical Solutions USA, Inc.
|
Motion Industries
|
Genuine Parts Company
|