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Audit Specialist

2 months ago

Fort Lauderdale, United States Polaris Pharmacy Services Full time
Job Details

Job Location
Polaris Pharmacy Services of Ft Lauderdale - Ft. Lauderdale, FL

Position Type
Full Time

Description

WHO WE ARE

Polaris Pharmacy Services is an industry leader in both Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies across the country. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members.

Job Details

The position will encompass working 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
  • To work with the Audit Manager to compile information for PBM, Medicare, Medicaid, facility and paper claims Audit requests. Perform internal auditing of claims for various teams. Assisting the billing team as needed. Gather information as appropriate per 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, Advanced Beneficiary Notices, etc..
  • Report to supervisor any apparent issues and coordinate submission of all required documentation.
  • Scan and upload audit request, submission, correspondence, findings, and results.
  • Assist with tracking and reporting of audit findings and results.
  • Research for documentation needed to complete the audits. Ensure all audits are reviewed by Pharmacist/Manager or other manager as directed prior to submission. Track audits in an organized, searchable and reportable method.
  • Manage multiple audits and, accurately and consistently track outcomes in multiple records. Results of audits will be analyzed and submitted to the audit team for discussion of issues and suggested improvements. Audit claims for various teams to ensure claims are submitted correctly. Track and distribute results to appropriate Management staff. Assist billing team as requested. Other duties as directed my manager.
Qualifications

Skills & Abilities
  • Knowledge of Medicare, Medicaid, and commercial pharmacy/LTC plan reimbursement methodologies and documentation requirements.
  • Excellent verbal and written communication skills.
  • Well organized, detail oriented and possess strong problem-solving and critical thinking skills.
  • Ability to prioritize tasks, manage multiple projects and work independently.
  • Computer Skills: Strong proficiency in Microsoft Office: Excel, Word, Outlook
  • Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
  • Ability to read and interpret documents such as Medicare, Medicaid and commercial health plan policy articles and procedure manuals.
  • Ability to prepare routine reports and correspondence.
  • Detail oriented Ability to write effectively Ability to research and effectively communicate findings Reimbursement Background preferred Collections and Cash posting knowledge preferred Experience with and detailed knowledge of Commercial / Pharmacy Practices preferred
Requirements
  • High School Diploma or equivalency
  • Proficiency with the Microsoft Suite
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 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