Staff Client Auditor Express Scripts
Locations: St. Louis, Missouri
Job ID: REQ20003776
Works with clients (and/or their auditors), governmental agencies such as Centers for Medicare and Medicaid Services, CMS, the Office of Inspector General, OIG, and their subcontractors, and Client Audit management as well as other ESI subject matter experts to resolve audit issues noted during the client audit process. May assist others on the team in researching audit findings or prepping for on-site audits. Track status and serves as main contact for clients during routine audits. Monitors contracts to ensure clients are requesting appropriate data. Assists with troubleshooting issues and questions arising from client audits. Coordinates with IS department to obtain applicable electronic files for the audits, ensuring all information is included and readable. Performs pro-active contract audits.
- Analyzes and investigates audit findings submitted by clients and their auditors to determine validity of identified discrepancies.
- Analysis includes, but is not limited to pricing, prior authorization, eligibility, plan set-up, financial and performance guarantees, rebates and formulary.
- Coordinates with cross-functional departments to obtain appropriate resolution to identified issues.
- Responsibility for handling/researching complex issues identified during an audit. More complex analysis and a more fluent knowledge of ESI systems are required in order to answer these complex issues.
- Writing skills need to be above standard in order to best communicate ESI findings regarding these complex issues.
- Needs to have adept discretionary judgment in their analysis and recommendations for outcomes.
- Develops ESI official response to the client identifying the issues raised by the client/auditor and provides a response to each issue.
- Response includes adequate reasoning and rationale to justify ESI’s position. Final response will also identify amounts, if any, for which the client will be reimbursed.
- Maintains significant documentation throughout the entire audit process. Outstanding organization skills are absolutely necessary
- Performs the entire Client Audit Process. This includes an identification of needs specific to each client. Obtains copies of all relevant documents and data which includes Confidentiality Agreements, claims data files, authorization letters, etc. Discusses the audit with the client (and/or their auditor), understanding and managing their expectations and working through any limitations that may be experienced due to confidentiality of information, etc.
- Tracks status and serves as main contact for clients during all audits.
- Conducts Audit conference calls with auditors, clients and other ESI employees to ensure that all individuals are aware of responsibilities and deadlines.
- Investigates and resolves client and auditor questions during the audit. Maintains periodic communication with Account Management throughout the audit.
- Receives more sensitive client – external auditor – ESI relationships that need to be handled with attentiveness and a high level of accuracy.
- Needs above average communication skills in order to communicate effectively in these sensitive situations.
- Needs to have adept discretionary judgment in their communications.
- Facilitates assigned on-site audits, which may include an operational review of various departments at ESI, prepping rebate and/or pharmacy contract information, as well as setting up tours of the mail order facility as necessary.
- Tracks status and serves as main contact for clients during routine audits and monitors contracts to ensure clients are requesting appropriate data.
- Performs pro-active contract audits using the Client Audit Resolution Tool.
- Works directly with Legal and the client to resolve issues of confidentiality agreements and any other legal conflicts that may arise.
- Works with accounting to coordinate payment information.
- Ensures clients receive payments.
- Special projects as assigned.
Qualifications / Requirements
- Bachelor’s degree in Finance, Accounting, or other business related field preferred
- 0-2 years of healthcare, financial analysis, accounting or auditing experience preferred.
- CPA or MBA desired
- Microsoft Office including Excel, Access, Word, and Outlook
- Knowledge of Express Scripts systems and operations preferred.