Pharmacist - Audit Program Advisor (12 month contract) - Express Scripts Canada

Recruiter
Cigna
Location
Mississauga, Ontario, Canada
Salary
Competitive salary
Posted
16 Sep 2020
Closes
18 Sep 2020
Ref
Cig20011551
Job role
Audit
The goal of the Business Integrity team is to evolve capabilities that effectively detect and address the fraud, waste and abuse of claims submitted on behalf of ESC customers. This role will focus on enhancing the Express Scripts Canada (ESC) value proposition for customers to ensure the integrity of health claims and benefit plans while maintaining a network of providers through diligent review, education and recovery of unsubstantiated funds. As a thought leader, the Senior Audit Program Strategy Leader will provide on-going professional guidance and recommendations that improve our capabilities to detect fraud, waste and abuse as well as providing education to service providers for all benefit types (pharmacy, extended health care services and dental). This role will work closely with data analysts, reporting specialists, investigators and auditors to ensure the governance and accuracy of service delivery. The candidate will work closely with the audit leadership team to assist with development of the audit program to ensure that the program remains current with changing pharmacy landscape and extended scope of practice.

This is a 12 month contract position

ESSENTIAL FUNCTIONS:
  • Recommend and help to prioritize potential provider audits based upon risk analysis of billed claims
  • Review audit reports for quality, accuracy, and proper audit application
  • Support auditors in responding to provider inquires, legal inquires and escalations
  • Continuously review and provide recommendations regarding claims verification risk criteria to ensure ESC is proactively identifying known industry risks for customers
  • Works with data analysts to analyze claims data and drug trends to forecast areas of program risk
  • Collaborate with leadership to review audit program to maximize program potential
  • Deliver evidence-based research to support discussions and decisions
  • Provide guidance and oversight to audit specialists
  • Review provider claims reports to identify abnormal or inconsistent claims submissions
  • Participate as required in peer reviews with external clients and provide support to audit specialists
  • Consult with internal and external stakeholders regarding audit activities
  • Support audit team in customer facing meetings
  • Additional duties as assigned by leadership
  • Recommend incremental and continuous ideas that will increase ability to prevent and manage risk that will bring the most value to customers


QUALIFICATIONS:
  • Bachelor of Science-Pharmacy or PharmD
  • Valid pharmacist licensure to practice pharmacy in Canada required
  • 5+ years of experience in a hospital, community pharmacy setting, or experience in group benefits including pharmacy benefits
  • Governance, regulatory and/or audit experience preferred
  • Knowledge of provincial and federal pharmacy regulations and legislative requirements
  • Demonstrated interpersonal skills to facilitate change management
  • team player and ability to work cross-functionally with other departments
  • Excellent time and resource management skills
  • Self-driven, curious, ability to work independently with minimal supervision
  • Proven ability to manage competing priorities in a fast based environment
  • Strong focus on quality and accuracy
  • Detail-oriented with proven high-level oral and written communication skills
  • Demonstrates and applies integrity in all aspects of work
  • Knowledge of Microsoft Office software (Word, Excel and PowerPoint)


About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.