Humana Pharmacy Desktop Auditor (Claims Professional 2) in Louisville, Kentucky


The Pharmacy Claims Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


Scope of Role and Responsibilities:As a Pharmacy Claims Professional 2 you will perform audit functions including review of pharmacy submitted documentation, responding to pharmacy inquiries and supporting other audit functions as needed.

Primary responsibilities include:• Initiate notifications of multiple types of pharmacy audits including Desktop, CMS and PDE audits.• Review prescription documentation provided by pharmacies, make determination of appropriate claim submissions, document and explain any discrepancies, respond to pharmacy inquiries and perform courtesy calls to pharmacies as needed.• Perform specific audit-related functions within the Audit program which can include calling on suspicious claim submissions, performing state specific law research and quality assurance.• Support the inbound mail and letter process as needed.• Maintain Pharmacy Technician Certification including learning industry changes and completing CE’s required to renew certification.

Key Competencies• Builds Trust: You honor your word by doing what you say you are going to do.• Drives for excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.• Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Required Qualifications• Prior problem solving experience, including root cause analysis and resolution• Excellent organizational and time management skills with attention to detail• Strong written and verbal communication skills• Proficiency in Microsoft Office applications, including Word and Excel• Currently Certified Pharmacy Technician (PTCB)

Preferred Qualifications• Prior pharmacy claims experience• Knowledge of Humana Pharmacy claims processing system and processes• Bachelor’s Degree or equivalent combination of education and experience

Scheduled Weekly Hours


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