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PAYER AUDIT SPECIALIST

Company: PharMerica
Location: Vancouver
Posted on: September 20, 2022

Job Description:

Our Company:PharMericaOverview:***$1,500 Sign-on/Retention Bonus!***
Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!
Hours: Monday thru Friday, 8:00am to 4:30pm
We offer:
DailyPayFlexible schedulesShift differentialHealth, dental, vision and life insurance benefitsCompany paid STD and LTDTuition AssistanceEmployee Discount Program401kPaid-time offTuition reimbursementNon-retail/Closed-door environment
Company Overview: We are a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression! If your passion is service excellence and top-quality care come join our team and apply today!
The Payer Audit Specialist receives and processes commercial and government payer audit requests for select Pharmerica locations. The Payer Audit Specialist reviews audit requests, compiles and classifies existing documentation, and identifies medical documentation needed to respond effectively and efficiently to these requests. The Payer Audit Specialist performs quality assurance checks of all medical and billing documentation before submission and notifies the Revenue Cycle Management (RCM) Ancillary Services management team or General Manager of any missing items, issues, or trends. The employee must have the ability to analyze, prioritize, problem solve, and multi-task. Above all, qualified candidates should possess exceptional internal and external customer service skills and actively promote Pharmerica's company culture.Responsibilities:

  • Ensures daily accomplishments by working toward individual and company goals for cash collections, payer audits, credit balances, medical records, correspondence, appeals/disputes, accounts receivable over 90 days, and other departmental goals
  • Understands and adheres to all applicable state/federal regulations and company policies
  • Receives, documents, processes, and tracks all incoming payer audit requests and updates until final resolution is obtained
  • 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 payer audit requests and submits responses within payer deadlines
  • Analyzes payer audit trends and communicates concerns and process improvement needs to the RCM Ancillary Services management team
  • Works within established departmental goals and performance/productivity metricsQualifications:
    • High School diploma/GED or equivalent required; some college a plus
    • A minimum of two to four years of experience in revenue cycle management with a strong working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement; audit experience a plus
    • Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus
    • Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, 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
    • Flexible schedule with the ability to work evenings, weekends, and holidays as neededAbout our Line of Business: PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.

Keywords: PharMerica, Vancouver , PAYER AUDIT SPECIALIST, Accounting, Auditing , Vancouver, Washington

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