QI CLAIMS AUDITOR

Description

CLAIMS AUDITOR 

We are seeking a Claims Auditor with QI experience to become part of our team!

Under general supervision of the QI Manager, and in accordance with local, state, federal and company laws and regulations ensure delivery of excellent customer service through fast, professional and accurate communication.

Hours:  9:00am-5:00pm, Monday-Friday 

RESPONSIBILITIES

• ·         Prepare and support timely and accurate responses to pharmacy payer audits, desk audits, and onsite audits.

  ·         Review claim data and dispensing records to identify billing errors, discrepancies, and compliance issues.

  ·         Obtain, validate, and organize requested documentation in support of audit responses.

  ·         Apply federal, state, and local pharmacy laws, payer policies, and internal procedures during audit reviews.

  ·         Document audit findings, corrective actions, and outcomes in accordance with department standards.

  ·         Utilize internal systems, tools, and reports to manage assigned audits and deliverables.

  ·         Communicate professionally with payers, auditors, consultants, pharmacies, facilities, prescribers, and partners to obtain required information.

  ·         Adhere to all company policies, best practices, and procedures, including protocols for identifying and escalating potential fraud, waste, or abuse.

  ·         Participate in report preparation, special projects, and continuous improvement initiatives.

  ·         Perform other related duties as assigned.

QUALIFICATIONS

• Registered with New Jersey Board of  Pharmacy, preferred 
• Knowledge of the practice of Long-Term Care Pharmacy including, but not limited to the areas of data entry, billing, and/or medical records
• MS OFFICE (Word, Excel) or Google Workspace (Docs, Sheets)
• Solution oriented and resourceful, demonstrates excellent problem solving and customer service skills.  Demonstrated process and project ownership orientation with the ability to manage a range of priorities and meet time commitments
• Skilled communicator in verbal, written and oral presentation.
• Ability to work independently with minimal direction and good decision-making ability.
• Demonstrated analytical, quantitative, and organizational skills providing the ability to analyze progress, identify trends and anomalies, and recommend needed improvements.

EEO Statement

Specialty Rx, INC is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state or local law.

EO/Minorities/Females/Disabled/Veterans

Please apply here https://secure3.saashr.com/ta/s6337.careers?CareersSearch

Requirements

Summary