Auditor

Orsini Healthcare; Elk Grove Village (IL); On-site; USD 29,000 - 39,000; Full time

Benefits offered by this job

Medical Coverage

401(k) with employer match

Accident and Critical Illness coverage

Company-paid life insurance options

Generous PTO, paid holidays, and float

Tuition reimbursement

Job summary

Orsini Rare Disease Pharmacy Solutions is seeking a Complex Auditor to join our Prior Authorization and Accounts Receivable teams. The role focuses on reviewing new and recurring prior authorizations for complex therapy lines to identify errors that could hinder reimbursement from Major Medical Insurance.

The ideal candidate has Medicare experience, collections background, and strong attention to detail in a fast-paced environment.

Qualifications

• High School Diploma or equivalent 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

• Review all new and recurring prior authorizations for Complex therapy lines.
• Audit and identify errors on prior authorizations that could prevent reimbursement.
• Collaborate with Prior Authorization and Accounts Receivable teams.
• Learn contract benefits and guidelines (Medicare/Medicaid) to maximize reimbursements.
• Update Audit Manager on urgent or special cases (e.g., legal cases).
• Performs other duties as assigned.

Skills

Medicare experience

Collections experience

Policy interpretation

Unit calculations

Detail-oriented

Fast-paced environment

Prioritization

Education

High School Diploma or equivalent

Job description

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 description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to 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

• 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