SHARED SVCS/PHARMACY CLAIMS MEDICARE AUDIT SPECIALIST

Research Medicare claims audits sent to the company by third party agencies within strict deadlines.

Communicate findings with divisions, pharmacies and nurse reviewers to reduce the number of claims that are recouped from the company and create Process Improvement Documents for the pharmacies.

Track recouped claims through pharmacy receivables system to ensure accounting and write-off is accurate.

Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.

Minimum
- Self-starting and able to perform job responsibilities minimal supervision
- Physical ability to access all necessary files
- Must be highly organized and detail oriented and able to function effectively in a multi-task environment
- Ability to work within strict deadlines
- Must be able to use discretion and maintain confidential information
- Ability to work well with others
- Strong analytical skills
- Good written and verbal communication and customer service skills
- Working knowledge of Microsoft Office, including Excel

Desired
- Basic insurance knowledge and Medicare/ Medicaid knowledge
- Knowledge of third-party operations and accounts receivable
- Knowledge of Pharmacy store systems (EasyFill PRN)- Research and track third party processor audits for assigned divisions/processors
- Maintain all incoming notices, original audit balances, final results, ending recoupment activity, and discrepancy codes for assigned audits
- Enter all audit information into the pharmacy accounting system for reporting and tracking
- Coordinate education calls with nurse reviewers to address audit denials and negotiate final financial results
- Create Process Improvement Documents for pharmacies and division coordinators
- Ensure audit deadlines are met and stores comply with audit notices
- Request medical records and/or proof of due diligence
- Provide timely accurate communication of information and accounting to the divisions regarding audit loss
- Attend CMS webinars throughout the year to maintain Medicare knowledge and any compliance updates/changes
- Must be able to perform the essential job functions of this position with or without reasonable accommodation