Auditor

Orsini; Elk Grove Village (IL); Hybrid; USD 34,000 - 44,000; Full time

Benefits offered by this job

Medical Coverage

401(k) with employer match

Life insurance options

Generous PTO and holidays

Tuition reimbursement

Job summary

Orsini Rare Disease Pharmacy Solutions seeks a Complex Auditor to collaborate with the Prior Authorization and Accounts Receivable teams to review new and recurring prior authorizations for complex therapy lines. The role audits and identifies errors that could prevent reimbursement from Major Medical Insurance.

The position emphasizes understanding contracts, benefits, Medicare/Medicaid guidelines, and timely updates to Audit Manager on urgent cases, with responsibilities spanning multiple

Qualifications

• High School Diploma or equivalent from accredited school required.
• Minimum 1-2 years of Medicare experience preferred.
• Previous collection experience preferred.
• Experience with Major Medical Insurance / Policy Interpretation.
• Knowledge of unit calculations based off prescriptions.
• Ability to work in fast-paced environment.
• Ability to prioritize workload.
• Must be extremely detail oriented.

Responsibilities

• Understanding systems which include patient and reimbursement files, pharmacy, equipment, and AR files.
• Verify and understand prior authorizations with Major Medical Insurance.
• Understand date span for required authorization approval.
• Responsible for learning all contract and associated benefits and guidelines (i.e. Medicare, Medicaid) to ensure maximum allowance in both realized and collected.
• Responsible for updating Audit Manager on urgent cases or special cases (ie. Legal cases, case manager issues).
• Performs other duties as assigned.

Skills

Medicare experience

Collection experience

Policy interpretation

Attention to detail

Thrives in fast-paced environment

Education

High School Diploma or equivalent

Job description

Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.

ABOUT ORSINI

Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.

OUR MISSION

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.

CORE VALUES

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.

COMPENSATION
The salary for this position is $25 per/hour.

POSITION SUMMARY
The Complex Auditor will work collaboratively with the Prior Authorization team and Accounts Receivable team to review all new and recurring prior authorizations for all Complex therapy lines. In combination, they will work diligently to audit and identify errors on prior authorizations which could prevent reimbursement from Major Medical Insurance.

ESSENTIAL DUTIES

• Understanding systems which include patient and reimbursement files, pharmacy, equipment, and AR files.
• Verify and understand prior authorizations with Major Medical Insurance.
• Understand date span for required authorization approval.
• Responsible for learning all contract and associated benefits and guidelines (i.e. Medicare, Medicaid) to ensure maximum allowance in both realized and collected.
• Responsible for updating Audit Manager on urgent cases or special cases (ie. Legal cases, case manager issues).
• Performs other duties as assigned.

Careers with real impact.

Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.

ABOUT ORSINI

Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.

OUR MISSION

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.

CORE VALUES

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.

COMPENSATION
The salary for this position is $25 per/hour.

POSITION SUMMARY
The Complex Auditor will work collaboratively with the Prior Authorization team and Accounts Receivable team to review all new and recurring prior authorizations for all Complex therapy lines. In combination, they will work diligently to audit and identify errors on prior authorizations which could prevent reimbursement from Major Medical Insurance.

ESSENTIAL DUTIES

• Understanding systems which include patient and reimbursement files, pharmacy, equipment, and AR files.
• Verify and understand prior authorizations with Major Medical Insurance.
• Understand date span for required authorization approval.
• Responsible for learning all contract and associated benefits and guidelines (i.e. Medicare, Medicaid) to ensure maximum allowance in both realized and collected.
• Responsible for updating Audit Manager on urgent cases or special cases (ie. Legal cases, case manager issues).
• Performs other duties as assigned.

Disclaimer: The information written in this job descriptionindicatesthe general nature and level of work to be performed. This job description is not designed tocontainor be interpreted astotally comprehensiveof every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee maybe requiredto perform other assignments not listed in this job description.

SKILLS & COMPETENCIES

• High School Diploma or equivalent from accredited school required.
• Minimum 1-2 years of Medicare experience preferred.
• Previous collection experience preferred.
• Experience with Major Medical Insurance / Policy Interpretation.
• Knowledge of unit calculations based off prescriptions.
• Ability to work in fast-paced environment.
• Ability to prioritize workload.
• Must be extremely detail oriented.

EMPLOYEE BENEFITS
We offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:

• Medical Coverage, Dental, and Vision Coverage
• 401(k) with employer match
• Accident and Critical Illness coverage
• Company-paid life insurance options
• Generous PTO, paid holidays, and floating holidays
• Tuition reimbursement program.

Equal Employment Opportunity

Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.

Americans with Disabilities Act

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

E-Verify Participation Notice

We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees.

All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system.

For more information about E-Verify, please review the official notices below:

E-Verify Participation Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf

Right to Work Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf