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

• Responsible for preparing and supporting with timely and accurate responses to payer claim audits and desk audits.

• Prepares and supports the completion of pharmacy payer audits, including claim data, reviewing dispensing activities for billing errors, obtaining and reviewing requested documentation, reviewing federal/state/local pharmacy laws, documenting audit results, and coordinating the submission of audit responses with Specialty Rx Pharmacies.
• Utilizes Frameworks as well as all Specialty Rx internal systems and reports to accomplish work deliverables.
• Communicates with pharmacy payers, auditors, consultants, etc. to discuss audit requests, responses, and results as needed using various media platforms (i.e. email, phone calls)
• Engages and follows up in correspondence with pharmacy, pharmacy partners, facilities, prescribers, providers, etc, in requesting documentation to validate detected claim discrepancies.

QUALIFICATIONS

• Registered with New Jersey Board of Pharmacy
• 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