Medicare Audit Specialist

6 days ago


Hutchinson, Kansas, United States Kroger Full time
Job Summary
Kroger is seeking a highly organized and detail-oriented MEDICARE AUDIT SPECIALIST - PHARMACY CLAIMS to join our team. In this role, you will research and track third-party processor audits for assigned divisions/processors, ensuring compliance with strict deadlines.

About the Role
This is a full-time position that requires strong analytical skills and attention to detail. As a MEDICARE AUDIT SPECIALIST - PHARMACY CLAIMS, you will be responsible for maintaining all incoming notices, original audit balances, final results, ending recoupment activity, and discrepancy codes for assigned audits. You will also enter all audit information into the pharmacy accounting system for reporting and tracking.

Responsibilities
- Research and track third-party processor audits for assigned divisions/processors
- Maintain all incoming notices, original audit balances, final results, ending recoupment activity, and discrepancy codes for assigned audits
- Enter all audit information into the pharmacy accounting system for reporting and tracking
- Coordinate education calls with nurse reviewers to address audit denials and negotiate final financial results
- Create Process Improvement Documents for pharmacies and division coordinators
- Ensure audit deadlines are met and stores comply with audit notices
- Request medical records and/or proof of due diligence
- Provide timely accurate communication of information and accounting to the divisions regarding audit loss

Requirements
- Self-starting and able to perform job responsibilities with minimal supervision
- Physical ability to access all necessary files
- Must be highly organized and detail-oriented and able to function effectively in a multi-task environment
- Ability to work within strict deadlines
- Must be able to use discretion and maintain confidential information
- Ability to work well with others
- Strong analytical skills
- Good written and verbal communication and customer service skills
- Working knowledge of Microsoft Office, including Excel

What We Offer
Kroger offers competitive compensation packages, excellent benefits, and opportunities for growth and development. The estimated salary for this role is $60,000 - $80,000 per year, depending on experience.

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