OverviewExpress Scripts Canada Next Day Pharmacy Auditor – 12 Months Contract Temporary in Mississauga, ON
Express Scripts Canada
Branch Mississauga ON CA
Next Day Pharmacy Auditor – 12 Months Contract
These PBM services are designed to facilitate better health decisions and to lower cost, including Active Pharmacy services, health-claims adjudication and…
Next Day Pharmacy Auditor – 12 Months Contract – REQ20004758 Express Scripts Canada, wholly owned by Express Scripts Holding Company, is one of Canada’s leading providers of health benefits management services.
From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector. These PBM services are designed to facilitate better health decisions and to lower cost, including Active Pharmacy services, health-claims adjudication and processing services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis. For more information about Express Scripts Canada, visit its Website at
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be. We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
The mission of Business Integrity is to enhance the Express Scripts Canada value proposition by leading the industry in developing and using highly innovative and effective audit techniques to ensure the integrity of health and dental claims while maintaining a superior network of providers through diligent review and education.
Express Scripts Canada is looking for an experienced Retail Pharmacy Technician/Assistant who is looking to take the next step in their career as a Next Day Pharmacy Auditor. The successful candidate will be able to demonstrate a strong ability to multi-take priorities while maintaining professional rapport with external customers.
- Conduct Next Day Pharmacy/MS&E audits to ensure that providers have the appropriate documentation to support claims in accordance with Provincial and Federal Legislation and their Provider Agreement.
- Analyze daily claims using established audit procedures to identify abnormal or inconsistent claims submissions.
- Accurately maintain electronic files for all audit related documentation.
- Maintain daily, weekly and monthly reports regarding the status of next day audit statistics.
- Verify audit data through communication with the prescriber and/or insured client to validate that paid services were authorized by the prescriber and received by the client.
- Apply corrective claims measures within the required timeline.
- Respond to external and internal queries and provide solutions to requests.
- Send and receive daily fax and email communication between the company and providers.
- Adhere to set timeframe to complete assigned workload.
- Contribute to process improvements and program initiatives.
- Other duties as assigned.
- Must have a minimum of three years recent retail pharmacy experience.
- Must have a diploma from an accredited Pharmacy Technician, Pharmacy Assistant Program or a diploma from a Canadian post-secondary educational program in the field of pharmacy.
- Must have working knowledge of DUR (Drug Utilization Review), compound pricing, third party insurance plans and COB (Coordination of Benefits).
- Must be proficient in Microsoft Office (Excel, Word, Outlook).
- Bilingualism (English and French) is an asset.
- Experience with compiling, manipulating or validating large amounts of data.
- Ability to maintain an electronic filing system.
- Proven time and resource management skills; detail oriented with strong organizational skills.
- Excellent verbal and written communication; ability to clearly convey program requirements.
- Ability to prioritize and organize personal workload.
- A team player who demonstrates mutual respect and applies integrity in their work.
- Is passionate about their role and willing to collaborate to produce quality results.
- Job requires precise finger/hand movements while working with a keyboard
- Need to remain at work station for lengthy periods
It will be a condition of employment that the successful candidate receives the Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation in order to receive Clearance. Candidates already possessing valid security clearance will be required to provide the following information: date of birth, security clearance level, and organization that currently holds your security clearance. Candidates who do not possess valid security clearance will be provided with the security forms and instructions via e-mail indicating how to complete and submit these documents.
Job Category General
Primary Location Canada-Ontario-Mississauga
Work Locations Mississauga, ON – 5770 Hurontario St.
5770 Hurontario St.
Mississauga L5R 3G5
Shift 1st Shift
Employee Status Temporary
Work From Home? No
Employment Type: Temporary
Location: Mississauga, ON, CA
Posted on: 2016-10-31