Senior Coordinator, Payor Relations Department Auditor – Monroeville, PA (Hybrid) @ CVS Health

Job Information

Job Description:

The primary responsibilities of the Payor Relations Auditor is department auditing of system setup and configurations. The Payor Relations Auditor will conduct quality control audit assessments and conduct routine reviews.  The Payor Relations Auditor will also be responsible for working with our internal auditors as well as E&Y to satisfy SOX controls.  Additionally, the Payor Relations Auditor will be responsible for reviewing, researching and determining resolution of incoming Payor Relations escalations as well as providing recommendations to streamline and/or implement processes to support the department.
Required Qualifications

• 1+ years of health care insurance experience
• Proficient Microsoft Office skills – Excel, Word, PowerPoint, OneNote, and Outlook experience.

Preferred Qualifications

• 1-2 years healthcare insurance experience.
• Ability to prioritize and work independently.
• Ability to work independently.
• Strong problem solving skills.
• Ability to meet deadlines across competing priorities
• Excellent organizational and prioritization skills.
• Excellent verbal, written and communication skills.
• Exhibits good judgment when escalating issues to management.
• Experience with Pharmacy Reimbursement based pricing and associated pricing compendia
• Knowledge of Reimbursement workflow, policies and procedures preferred
• Experience with large, multi-geographic organizations and diverse culture

EDUCATION

• Verifiable High School Diploma or GED is required.

Company Information

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