CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

The Audit Specialist II is responsible for facilitating processing of audits within the parameters of the audit program. The role involves reviewing claim submissions for accuracy, identifying root causes of claim issues, with the goal of resolving discrepancies and sharing findings with leadership. The ideal candidate will have knowledge of home infusion, state and federal guidelines, and payer requirements, as well as strong communication and problem-solving skills. The position requires attention to detail, the ability to work independently, and proficiency in Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.

Responsibilities

Effectively prioritize and complete all assigned tasks

Complete payer audits in a timely manner and before deadlines

Maintain a current knowledge base of state and federal guidelines, and payer requirements, including but not limited to, Medicare, Medical Assistance, Highmark and UPMC Health Plan.

Perform quarterly quality audit checks

Complete quality audits on new employees until accuracy threshold is met

Perform claim denial audits

Complete ongoing quality focus audits on billing and collection activity

Assist with training on recurring errors found during quality audits

Assist in development of Standard Operating Procedures

Complete special projects as requested

Perform in accordance with system-wide competencies/behaviors

Skills & Abilities

Minimum 4 years’ experience in home infusion revenue cycle

Strong knowledge of Federal and State billing guidelines

Working knowledge of basic medical terminology required

Excellent verbal and written communication skills

Strong customer service orientation

Excellent problem-solving skills

Strong interpersonal and organizational skills, with the ability to work on multiple tasks simultaneously with attention to detail

Experience with CPR+ Software

Requirements

High School diploma or GED

Proficiency in the Microsoft Office Suite

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.