Payer Audit Specialist

PharMerica; Vancouver (WA); On-site; USD 28,000 - 29,000; Full time

Job summary

PharMerica is seeking a Payer Audit Specialist to receive and process payer audit requests for select Pharmerica locations. You will review requests, compile documentation, and identify items needed to respond efficiently, while ensuring quality in medical and billing materials before submission.

Applicants should have 2–4 years in revenue cycle management with payer experience, strong communication skills, and the ability to multi-task within regulatory guidelines.

Qualifications

• Minimum 2–4 years in revenue cycle management with payer experience.
• Knowledge of Managed Care, Commercial, Government, Medicare and Medicaid reimbursement.
• Experience with automated billing systems; CPR+ and Waystar a plus.
• Strong attention to detail and ability to manage workflow volumes.
• Excellent verbal and written communication skills.

Responsibilities

• Process and track payer audit requests to final resolution.
• Document, compile, and classify audit materials for responses.
• Coordinate with departments to ensure proper review and appeals.
• Analyze audit trends and report issues to the RCM Ancillary Services team.
• Maintain adherence to state/federal regulations and company policies.
• Manage daily tasks to meet deadlines and performance metrics.

Skills

Revenue cycle management

CPR+ & Waystar

Medical coding ICD-9/10 CPT HCPCS

MS Office; 40 WPM

Verbal & written communication

Regulatory knowledge (federal/state)

Education

High School diploma/GED

Some college a plus

Tools

CPR+

Waystar

Job description

Overview

The Payer Audit Specialist receives and processes commercial and government payer audit requests for select Pharmerica locations. The Payer Audit Specialist reviews audit requests, compiles and classifies existing documentation, and identifies medical documentation needed to respond effectively and efficiently to these requests. The Payer Audit Specialist performs quality assurance checks of all medical and billing documentation before submission and notifies the Revenue Cycle Management (RCM) Ancillary Services management team or General Manager of any missing items, issues, or trends. The employee must have the ability to analyze, prioritize, problem solve, and multi-task. Above all, qualified candidates should possess exceptional internal and external customer service skills and actively promote Pharmerica’s company culture.

Our Company

PharMerica

Responsibilities

• Ensures daily accomplishments by working toward individual and company goals for cash collections, payer audits, credit balances, medical records, correspondence, appeals/disputes, accounts receivable over 90 days, and other departmental goals
• Understands and adheres to all applicable state/federal regulations and company policies
• Receives, documents, processes, and tracks all incoming payer audit requests and updates until final resolution is obtained
• Communicates and coordinates across departments to ensure audits receive the proper review, appeals, and resolution
• Coordinates with other departments to obtain documentation and justification for medical services rendered. Assembles documentation, composes appeal responses, and submits back to payers in the required format.
• Responds timely to all payer audit requests and submits responses within payer deadlines
• Analyzes payer audit trends and communicates concerns and process improvement needs to the RCM Ancillary Services management team
• Works within established departmental goals and performance/productivity metrics

Qualifications

• High School diploma/GED or equivalent required; some college a plus
• A minimum of two to four years of experience in revenue cycle management with a strong working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement; audit experience a plus
• Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus
• Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, CPT, HCPCS coding, and medical terminology
• Solid Microsoft Office skills with the ability to type 40+ WPM
• Strong verbal and written communication skills with the ability to independently obtain and interpret information and compose written audit responses
• Strong attention to detail and ability to be flexible and adapt to workflow volumes
• Knowledge of federal and state regulations as it pertains to revenue cycle management, a plus
• Flexible schedule with the ability to work evenings, weekends, and holidays as needed

About Our Line Of Business

PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook , Twitter , and LinkedIn .

Salary Range

USD $20.00 - $21.00 / Hour