Do you want to help make healthcare more effective and affordable for everyone? That’s our mission at Codoxo. The U.S. spends more on healthcare than any other country in the world, but not all of the $3.8 trillion goes to real patient care. A significant portion, up to 10% or $380 billion, is lost to fraud, waste, and abuse.

Codoxo is an AI-assisted platform that accelerates the identification of fraud, waste, and abuse in Healthcare which costs the nation $270B annually. Codoxo is rapidly growing and has won numerous awards. We are seeking exceptional talent to achieve our goal of ensuring that our scarce healthcare dollars go to real patient care.

Primary Responsibilities:

·       Proactively identify instances of potential fraud, waste, and abuse through data analysis using company system and tool

·       Perform data analytics to identify fraud, waste, or abuse in claims data

·       Responsible for investigating, researching, and analyzing software data in order to detect fraudulent, abusive, or wasteful activities/practices.

·       Assist engineering and data science teams with audit and FWA concepts, data mapping, and data definitions

·       Use knowledge of pharmacy auditing, fraud schemes, general areas of vulnerability, reimbursement methodologies, and relevant laws to find suspicious patterns in claims data and other sources

·       Develop and maintain general knowledge of pharmacy reimbursement policies and state and federal regulations related to pharmacy fraud and abuse

·       Communicate with customers regarding findings from company software and assist with navigating company software

·       Work cooperatively and constructively with team members, including mentoring, training, and assisting team members as required

·       Perform additional duties and projects as assigned by management

·       Maintain security and confidentiality of all protected health information encountered in performance of duties

 

Required Qualifications:

·       Certified Pharmacy Technician (CPhT) active license

·       3+ years of experience working in a pharmacy fraud, audit, compliance, or cost containment role

·       3+ years of experience within the PBM, health plan pharmacy, government pharmacy, or other similar Industry role

·       High School Diploma /GED or higher

·       Competency in Excel – creating/updating spreadsheets, pivot tables, and formulas

·       2+ years Pharmacy technician experience in a retail pharmacy setting

·       Experience with Medicare Part D

 

 

Preferred Qualifications:

·       Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar

·       Health Plan pharmacy experience

·       Experience with issue resolution