Audit Compliance Specialist

3 days ago

Louisville, Kentucky, United States BrightSpring Health Services Full time

{"h1": "Audit Compliance Specialist", "p": "We are seeking a highly skilled Audit Compliance Specialist to join our team at PharMerica. As a key member of our audit team, you will be responsible for managing all inbound onsite and desk audit communications and requests from 3rd Party Payers or auditing companies. Your primary focus will be on ensuring timely compliance with all audit requests, while maintaining strong attention to detail and follow-up. If you have a strong background in audit industry and excellent communication skills, we encourage you to apply for this exciting opportunity.", "ul": [{"li": "Manage all inbound onsite and desk audit communications and requests from 3rd Party Payers or auditing companies"}, {"li": "Consolidate and provide all necessary instructions and documents, and distribute them to pharmacy personnel in a timely manner"}, {"li": "Follow up with pharmacies to ascertain status of all audit requests to ensure compliance and timeliness of all designated due dates"}, {"li": "Develop a deadline tracking process to ensure nothing is overlooked or missed"}, {"li": "Coordinate the rescheduling of conflicting audit due dates with the Third Party Payer, Audit Vendor, Auditing Companies and pharmacy, as necessary to provide a sufficient time period for proper audit preparation"}, {"li": "Ensure that supporting documentation for disputable discrepancies is complete and accurate and sent to the Third Party Payer or Audit Vendor by the stated due date to mitigate overall financial risk"}, {"li": "Update and maintain the audit database with payer audit statistics to support 3rd Party Audit analytics and reporting"}, {"li": "Work with Department Manager on the collection of data - at the claim level - of all audits from the initial notification to final outcomes"}, {"li": "Obtain final audit recoupment detail from Third Party Payer or Audit vendor and provide it to the 3rd Party Reconciliation team to facilitate the proper processing of the financial recoupment"}, {"li": "Perform other tasks and projects as assigned"}, {"li": "Conduct job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards"}, {"li": "To perform this job successfully, an individual must be able to perform each essential duty satisfactorily"}, {"li": "The requirements listed above are representative of the knowledge, skill, and/or ability required"}, {"li": "Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions"}], "h2": "Qualifications", "ul": [{"li": "Minimum of an Associate's Degree or equivalent work experience in audit industry required"}, {"li": "Bachelor Degree in Accounting, Finance, Business, or Pharmacy Technician License desired"}, {"li": "1 to 3 years (accounting, auditing, analysis, retail or LTC pharmacy) required"}, {"li": "3rd Party Audit, PBM Audit, Pharmacy Provider Audit experience desired"}, {"li": "Demonstrated ability to communicate clearly, accurately and tactfully, both verbally and in writing"}, {"li": "Time Management Skills that will ensure timely compliance with all audit requests"}, {"li": "Proven ability to work with minimal supervision while paying strong attention to detail and follow-up"}, {"li": "Demonstrated strong organizational skills to handle multiple tasks and to complete projects, as required"}, {"li": "Solid working knowledge of all MS Operating systems and MS Office applications, including Excel, Word, and Access"}, {"li": "Ability to work in strict confidence, ensuring the confidentiality of patient and medical and financial records, at all times, in compliance with company and HIPAA Privacy guidelines"}, {"li": "Pharmacy Technician certification desired"}, {"li": "Strong interpersonal skills to work effectively with internal and external customers. A self-starter with a commitment to continuous process improvements and improved service levels"}]}

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