Payer Audit Specialist

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

Benefits offered by this job

Competitive Pay

Health, Dental, Vision & Life

Company-Paid Disability

Flexible Schedules & PTO

Tuition Reimbursement

Employee Discount & DailyPay

401k

Pet Insurance

Job summary

PharMerica is seeking a Payer Audit Specialist to handle commercial and government payer audit requests for select locations. You will review requests, compile documentation, identify required medical records, and perform quality checks before submission.

In this role you will coordinate across departments to ensure proper reviews, appeals, and timely responses, while adhering to regulations and company policies. A strong customer service focus is essential.

Qualifications

• Minimum two to four years in revenue cycle management.
• Experience with Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement.
• Experience with CPR+ and Waystar preferred.
• Knowledge of ICD-9/10, CPT, HCPCS coding and medical terminology.
• Strong MS Office skills and typing 40+ WPM.

Responsibilities

• Ensures daily accomplishments toward cash collections, payer audits, credit balances, medical records, and correspondence.
• Adheres to state/federal regulations and company policies.
• Receives, documents, processes, and tracks all incoming payer audit requests to resolution.
• Coordinates with departments to ensure proper review, appeals, and resolution of audits.
• Assembles documentation and submits appeal responses in required payer format.
• Responds timely to all payer audit requests and deadlines.
• Analyzes payer audit trends and communicates improvement needs.

Skills

Verbal communication

Written communication

Attention to detail

MS Office

Typing speed

Education

High School diploma/GED

Tools

CPR+

Waystar

Billing systems

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

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.

Schedule:

Monday - Friday

8 am -4:30 pm PST

• Competitive Pay


• Health, Dental, Vision & Life Insurance


• Company-Paid Short & Long-Term Disability


• Flexible Schedules & Paid Time Off


• Tuition Reimbursement


• Employee Discount Program & DailyPay


• 401k


• Pet Insurance

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