Audit Specialist - Pharmacy

Audit Specialist - Pharmacy

Job Locations

US-CO-ENGLEWOOD

ID

Line of Business

Amerita

Position Type

Full-Time

Pay Min

USD $20.00/Hr.

Pay Max

USD $26.00/Hr.

Our Company


Overview

Amerita is a leading provider of Specialty Infusion services

focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. As one of the most respected Specialty Infusion providers in America, we service thousands of patients nationwide through our growing network of branches and healthcare professionals.
Providing service to all the Amerita locations, the PBM Payer Audit Specialist reviews audit request, compiles and classifies existing documentation and identifies documentation needed to respond effectively and efficiently. The PBM Payer Audit Specialist also performs quality assurance checks for all medical and PBM billing documentation before submission and notifies the RCM Ancillary Services management team or General Manager of any missing items, issues, or trends.
• Medical, Dental & Vision Benefits plus, HSA & FSA Savings Accounts
• Supplemental Coverage - Accident, Critical Illness and Hospital Indemnity Insurance
• 401(k) Retirement Plan with Employer Match
• Company paid Life and AD&D Insurance, Short-Term and Long-Term Disability
• Employee Discounts
• Tuition Reimbursement
• Paid Time Off & Holidays

Responsibilities

Receives, documents, processes, and tracks all incoming PBM payer audit requests and updates until final resolution is obtained. Responsible for correcting PBM claim audit deficiencies and resubmitting claims back to the payer as needed

Responsible for cross training and providing support to handle incoming payer medical audits
Communicates and coordinates across departments to ensure audits receive the proper review, appeals, and resolution
Coordinates with other departments to obtain documentation and justification for medical services rendered. Assembles documentation, composes appeal responses, and submits back to payers in the required format
Responds timely to all PBM payer audit requests and submits responses within payer deadlines
Analyzes PBM payer audit trends and communicates concerns and process improvement needs to the RCM Ancillary Services management team
Records payer audit responses utilizing the appropriate subject headers and templates in CPR+ and the Payer Audit Tracking spreadsheet
Utilizes most efficient resources to submit PBM payer audits, giving priority to electronic solutions
Maintains CPR+ Document Management system to include faxing, scanning, and attaching documents
Oversees the PBM Test Claim report and works to resolve rejected submissions to avoid erroneous payments
Assists with pulling manufacturer invoices needed for PBM and medical audits
Reviews PBM credit balances and works with payer to resolve through payer refunds or using Amerita's approved adjustment codes

Qualifications

Successful completion of an approved/accredited Pharmacy Technician training program strongly preferred
1-3 years of related pharmacy experience in a home care setting
Basic pharmacy knowledge of reading and interpreting prescriptions and submitting pharmacy claims to PBM payers.
Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus.
Working knowledge and application of metric measurements, basic accounting practices, ICD 10, CPT, HCPCS coding, and medical terminology.
Solid Microsoft Office skills with the ability to type 40+ WPM.
Strong verbal and written communication skills with the ability to independently obtain and interpret information and compose written audit responses.
Strong attention to detail and ability to be flexible and adapt to workflow volumes.
Knowledge of federal and state regulations as it pertains to revenue cycle management, a plus.

About our Line of Business

Amerita is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness and entrepreneurial spirit of a local provider. For more information about Amerita, please visit

Follow us on TwitterandLinkedIn.

Salary Range

USD $20.00 - $26.00 / Hour