Ambulatory Regulatory Technician

3 weeks ago

Philadelphia, United States Pennsylvania Medicine Full time

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Perelman Retail Pharmacy

Summary:

  • Under the general observation of the Associate Director of Pharmacy and the Outpatient Pharmacy Managers, the Ambulatory Regulatory Technician assists the Managers in the evaluation, reporting and monitoring of all aspects pertaining to pharmacy payer audits and regulatory compliance.
  • The Ambulatory Regulatory Technician is responsible for helping to manage the internal and external pharmacy payer audits and requirements in accordance with Federal, State and Internal auditing standards. The Ambulatory Regulatory Technician will assist in the day-to-day activity of the outpatient pharmacy locations insurance audit requests, as well as proactive audits and regulatory compliance. The Ambulatory Regulatory Technician services more than 6+ retail pharmacy locations in both Philadelphia and suburban locations. In addition to data compilation for fax or electronic audit, the auditing technician will support the managers during in person audits, proactively audit claims for accuracy and support needed regulatory requirements. The purpose of the Ambulatory Regulatory Technician is to help drive overall fiscal and regulatory performance and manage the daily activities of the insurance payer programs. Key responsibilities will include ensuring timeliness of payer audit completion, ensuring accuracy of information submitted, assessing the risks in the pharmacy audit assignment, perform appropriate audit procedures, draft and communicate audit findings and observations and collaborate with pharmacy management to resolve issues in a timely and efficient manner.
Responsibilities:
  • Conducts desktop and onsite audits for the HUP Pharmacies and in accordance with Federal, State, and Internal Audit standards
  • Proactive claims auditing to ensure the appropriateness and accuracy of submitted pharmacy claims
  • Handling third-party requests in coordination with the Pharmacy Managers
  • Auditing delivery processes to ensure medications are delivered and receipts are on record
  • Within the general guidelines provided by management, will conduct the following tasks: assess the risks in the pharmacy audit assignment, perform appropriate audit procedures, draft and communicate audit findings and observations, and collaborate with pharmacy management to resolve issues in a timely and efficient manner
  • Assists with ongoing regulatory compliance and accreditation surveys and monitors compliance with billing practices and collection of copays
  • Leads meetings in conjunction with management and performs quality assurance checks of pharmacy payer documentation to ensure accuracy and completeness.
  • Completion of payer regulatory requirements
  • Performs 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
Credentials:
  • Pharmacy Technician Certification Required (CPhT)
Education or Equivalent Experience:
  • H.S. Diploma/GED (Required)

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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