Pharmacy Claims Audit Specialist, CPhT

JOB DESCRIPTION

Track, research, and resolve processor claims audits received by the company from various third-party agencies within strict deadlines. Communicate with divisions, pharmacies, and insurance companies to reduce the number of claims that are recouped from the company. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.

RESPONSIBILITIES

- Research and track third-party processor audits for assigned divisions/processors
- Maintain all incoming notices, original audit balances, final results, and ending recoupment activity for assigned audits
- Enter all audit information into the pharmacy accounting system for reporting and tracking
- Ensure audit deadlines are met and stores comply with audit notices; dispute any necessary items as required
- Research/respond to agency/store/division inquiries or questions regarding third-party processor audits
- Coordinate rebilling work with the aging team as needed
- Provide timely accurate communication of information and accounting to the divisions regarding audit loss
- Must be able to perform the essential job functions of this position with or without reasonable accommodation

QUALIFICATIONS

Minimum
- Nationally Certified Pharmacy Technician
- Self-starter with ability 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 oral 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)