Client Audit Manager, CVS Health

CVS Health

Location:

United States

Category:

Finance

Contract Type:

Not provided

Salary:

54300.00 - 132600.00 USD / Year

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Job Description:

CVS Health is currently looking for a dynamic individual to join our team in a Manager role. In this client facing project management role, you will be responsible for coordinating, managing and assisting with audits and using broad and deep system set-up and adjudication knowledge. In this position you will work closely with various government auditors, 3rd party consultants and auditors, client account teams, legal and trade areas to ensure the completion of government audits with consistency and minimal disruption to the business. Additionally, you will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process and to improve, develop and deliver on automation projects and complex analyses specifically related to audit deliverables. This position will also be expected to be analytical, able to understand regulation and identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions. This includes having an extensive knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review and respond to all the auditor questions in a short window of time. This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.

Job Responsibility:

Work directly with the government auditors, the client and all the internal business areas involved in the audit
Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities
Have a deep knowledge base of Medicaid and Exchange regulations, as well as having some knowledge around Med D
Work independently with limited direction from the Sr Manager
Coordinate, manage, track the audits from start to closure
Review and research all questions from the auditor and client
Work through and resolving any alleged issues
working strategically and achieving results
Work with the right business leaders to ensure responses are accurate and senior leaders are aware of any issues in accordance with regulatory timelines
Respond back to the auditor / client
Understand the intricacies of claim adjudication in order to answer questions related to the various claim testing sections, answering their questions correctly and confidently
Identify process enhancements, as well as any gaps in controls within the business areas being audited
Raise the appropriate items to senior leaders and doing so timely
Documenting correspondence with internal partners, clients, and auditors
Tracking all audit progress to ensure that all deliverables are provided by due dates

Requirements:

5+ years of prior relevant experience in audit, project management, or financial advisory role
3+ years pharmacy claim experience
A deep understanding of pharmacy claim adjudication
Ability to actively seek new ways to grow and be challenged
Critical thinking which translates into strategic actions
Easily adapting to change
Excellent verbal and written communications skills and experience communicating/presenting with all levels of leadership
Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion
Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must
Strong ability to maintain attention to detail and organizational skills
Team building skills that effectively influence and engage others in issue resolution
Solves complex problems
takes a new perspective on existing solutions
exercises judgment based on the analysis of multiple sources of information
Uses best practices and knowledge of internal or external business issues to improve products or services
Strong ability to hold oneself and others accountable for mitigating risk and achieving results

Nice to have:

CPA, CIA or MBA preferred
Medicaid operational experience
Internal or external audit experience
Demonstrated excellent verbal and written communications skills
Proficiency in Microsoft Word, Excel, PowerPoint
PBM Experience is also desired

What we offer:

The Company offers a full range of medical, dental, and vision benefits
Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees
The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits
CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners
As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year

Additional Information:

Job Posted:

March 29, 2025

Expiration:

April 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Client Audit Manager