Billing Audit Specialist

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team oriented, and quality work environment for our employees that cultivates achievement and success.

Job Description:
The Billing Audit Specialist reviews the services provided and compares them to EHR and billing records to determine accuracy and is responsible for performing quality reviews to validate the integrity of billing procedures. This role is also responsible for ensuring that billing is optimized, and errors are minimized by identifying opportunities through audit and observation. The Billing Audit Specialist remains abreast of regulatory and procedure changes which may affect billing compliance and /or reimbursement.

General Duties:

Under the direct supervision of the Sr. Manager Accreditation and Quality, the Billing Audit Specialist will be responsible for the following:

• Conducting compliance Billing Audits to ensure data integrity, compliance with federal and state regulations pertaining to, but not limited to billing of prescription drugs and services.
• Clearly documenting findings related to work performed.
• Communicating any identified patterns of error that may create institutional risk.
• Drafting audit findings report and assisting in the organization of documentation to support and communicate audit findings.
• Assisting with developing training sessions for billing staff and others regularly scheduled or ad hoc.
• Staying current on current federal, state and payer documentation, billing and coding rules and regulations.
• Developing and fostering working relationships with external and internal applicable working counterparts (i.e., nursing, IT, revenue cycle management, Finance, and others) to provide data and analytics, report issues, mitigate findings, and facilitate productive exchange of information to achieve and sustain compliance.
• Developing audit tools for proper identification, reconciliation, resolution.
• Managing and preparing responses to payer audits.
• Escalating any identified issues as they arise during the monitoring, auditing, and reconciliation process.
• Working with internal and external parties to develop and validate action plans. Follows up on progress and completion of action plans, as necessary.
• Identify and track trends with repeat audit issues.
• Assisting with accreditation efforts, including site visits and document gathering and submission.
• Assisting with processing of medical records requests.
• Actively participating in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
• Aligning actions and actively supporting company goals and objectives while working within organizational protocols, company policies and regulatory requirements.
• Adhering to appropriate safety and quality assurance practices.
• Present a professional appearance & approach plus demonstrate honest & ethical behavior.
• Handling company info with appropriate sensitivity & safeguards to ensure confidentiality & right to privacy, in compliance with applicable local, state, and federal laws.
• Contributing to the effectiveness of the team by working together by supporting, promoting, and applying the best practice standards of conduct including those on attendance, mutual respect and support, honoring diversity, effective communication, and improving the work environment.
• Exhibiting flexibility when work assignments need to be adjusted to meet service, delivery and workload needs of team.
• Taking initiative to identify, develop & adapt new policies and practices that improve quality of work.
• Understanding and complying with healthcare regulatory environment, local, state, and federal laws.

Required Education, Certification, Experience and Skill Requirements:

• Associates degree or equivalent
• Minimum of (5) years in pharmacy operations, and audit experience
• Able to work under pressure and meet deadlines.
• Able to identify and resolve issues quickly and efficiently.
• Excellent communication, problem solving and organizational skills with a strong attention to detail, accuracy, and follow through.
• Strong customer service and interpersonal skills.
• Strong pharmacy background with experience in claim adjudication and billing.
• Accepts change and adapts in a positive and productive manner; handles unexpected situations and change.
• Works independently as needed to finish own work assignments but also manages team environments successfully to maximize department, output, and accuracy.
• Proficiency in Microsoft Office.
• Familiarity with ACHC, URAC, and other healthcare provider accreditation bodies.
• Familiarity with HIPAA, Fraud, Waste and Abuse and other relevant healthcare laws.

Preferred Certification, Experience and Skill Requirements:

• Coding and Billing Certification
• CPR+ experience
• Pharmacy technician license; active and in good standing.

Physical Demands:

Required to stand, walk, sit, talk, and hear; required to use hands to operate vehicles and office equipment; must be able to occasionally lift and/or move up to 25 lbs; specific vision requirements for this job include: close, distance and peripheral vision, and the ability to adjust focus, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

InfuCare Rx is an equal opportunity employer. All employment decisions are made without regard to race, color, religion, national origin, military status, marital status, citizenship/immigration status, sex (including pregnancy and relation conditions, sexual orientation, or gender identity), age (40 and older), disability, genetic information (including employer requests for, or purchase use, or disclosure of genetic tests, genetic services, or family medical history), retaliation for filing a charge, reasonably opposing discrimination, or participating in a discrimination lawsuit, investigation, or proceeding. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• Remote

Application Question(s):

• What is your highest level of education?
• Please describe your experience in auditing.
• Please describe your experience in medical claim billing.
• Do you have experience with the healthcare software known as CPR+

Work Location: Remote