Pharmacy Claims Reviewer (CPhT):
Conduent Incorporated

Conduent Incorporated
Philadelphia Pennsylvania
About Conduent

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Description

* Position Responsibilities
* Examine and interpret pharmacy records against submitted claim data for potential discrepancies
* Utilize specific client instructions, federal and state regulations and standards of practice to properly access pharmacy documentation
* Research board of pharmacy regulations as well as state and federal laws as they relate to prescription requirements and pharmacy practices
* Respond to pharmacy calls in regards to audit results
* Deal with clients periodically to report audit results
* Conduct Onsite and Desktop and Credentialing Audits in a professional and respectful manner
* Use prescription knowledge to review pharmacy submitted documentation against submitted claim data
* Assess, and produce detailed descriptions of pharmacy operations and procedures
* Make confirmation calls to pharmacies prior to audit date
* Personally handle audit reschedules
* Must be able to stand for long periods of time (Up to 8 hours)
* Must be able to lift heavy boxes containing prescription records
* Call Center Assistance
* Responsible for covering incoming phone calls for a portion of the day
* Process incoming and outgoing correspondence as required
* Other duties and responsibilities as assigned

Required Skills

* National CPhT Certification through the Pharmacy Technician Certification Board(PTCB)
* 5+ years retail pharmacy experience
* Long Term Care/Infusion pharmacy experience favorable
* Proficiency in Windows and Microsoft Office preferred
* Must live in commuting distance of Cherry Hill, NJ for occational office meetings, but it is virtual most of the time.


Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy.