Ambulatory Regulatory Tech

17 hours ago

Philadelphia, United States Compunnel Full time
Job Summary:

The Ambulatory Regulatory Technician is responsible for managing internal and external pharmacy payer audits and requirements in accordance with Federal, State, and Internal auditing standards. This role supports the day-to-day activities of outpatient pharmacy locations, including insurance audit requests, proactive audits, and regulatory compliance. The technician services over 6 retail pharmacy locations in Philadelphia and suburban areas, compiling data for fax or electronic audits, supporting managers during in-person audits, and ensuring regulatory requirements are met.

Key Responsibilities:

• Conduct desktop and onsite audits for HUP Pharmacies in accordance with Federal, State, and Internal Audit standards.

• Proactively audit claims to ensure the appropriateness and accuracy of submitted pharmacy claims.

• Handle third-party requests in coordination with Pharmacy Managers.

• Audit delivery processes to ensure medications are delivered and receipts are on record.

• Assess risks in pharmacy audit assignments, perform appropriate audit procedures, draft and communicate audit findings and observations, and collaborate with pharmacy management to resolve issues.

• Assist with ongoing regulatory compliance and accreditation surveys, and monitor compliance with billing practices and collection of copays.

• Lead meetings in conjunction with management and perform quality assurance checks of pharmacy payer documentation to ensure accuracy and completeness.

• Complete payer regulatory requirements.

• Perform duties in accordance with Penn Medicine and entity values, policies, and procedures.

• Other duties as assigned to support the unit, department, entity, and health system organization.

Certification: Certified Pharmacy Technician (CPhT)

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