3rd Party Auditor/ Audit Specialist

WHO WE ARE 

Polaris Pharmacy Services is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies in 9 different cities throughout the Southeast, Northeast, and Midwest. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members. Currently, we are recruiting for an experienced 3rd PartyAudit Specialist to join the Polaris team.

OVERVIEW

The 3rd PartyAudit Specialist position will encompass working on Medicare, Medicaid, Pharmacy, Major Medical and facility Audits. This position will also assist with watermarking duties, billing duties and assist with audit appeals as directed by Management. This position requires strict compliance with all HIPAA and FWA standards and privacy standards.

RESPONSIBILITIES

• Collaborate with the Audit Manager to compile data for PBM, Medicare, Medicaid, facility, and paper claims Audit requests, conduct internal audits for multiple teams, and provide support to the billing team as required.
• Collect relevant information in accordance with the audit request.
• Retrieve all documentation, including but not limited to proof of delivery, written orders, clinical test results, letters of medical necessity, medical record notes, signature attestations, and Advanced Beneficiary Notices, as required.
• Report any apparent issues to the supervisor and coordinate the submission of all necessary documentation.
• Scan and upload audit requests, submissions, correspondence, findings, and results.
• Assist with tracking and reporting of audit findings and results.
• Research the documentation needed to complete the audits.
• Ensure all audits are reviewed by the Pharmacist/Manager or other manager as directed before submission.
• Track audits in an organized, searchable, and reportable manner.
• Manage multiple audits and accurately and consistently track outcomes in multiple records.
• Analyze the results of audits and submit them to the audit team for discussion of issues and suggested improvements.
• Audit claims for various teams to ensure correct submissions and subsequently track and distribute the results to the relevant management staff.
• Assist the billing team as requested.
• Perform additional tasks as instructed by the manager.

QUALIFICATIONS

• High School Diploma or equivalency
• Proficiency with Microsoft Suite software

PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day.
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, crouch, walk, crawl intermittently.
• May be necessary to work extended hours as needed.
• May lift and/or move up to 50 pounds.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role.

HOLIDAY & PTO POLICY

We provide qualifying full-time employees with 23 PTO (Paid Time Off) days annually.  PTO is used for holidays, vacation, sick leave, and personal leave.

Please note we are a long-term care pharmacy open 24 hours a day, 7 days a week. And schedules may change as determined by the needs of the business.

BENEFITS – for full-time employees

• Medical, Dental, Vision insurance, and Life insurance
• 401 (k) (available for Part Time & Full Time EEs)
• Short-term and Long-term disability insurance
• Tuition reimbursement
• Personal Time Off (PTO)
• Competitive pay with annual performance reviews and merit-based raises
• Career growth potential
• Annual on-site voluntary Flu Vaccines
• Employee referral bonus program