Job Description

Summary

The Revenue Cycle Auditor is responsible for verifying that revenue cycle practices for the specialty pharmacy are in line with all payers, state and federal compliance guidelines. The Auditor will review, analyze, authenticate, and confirm billing accuracy and collection competency. Research and investigate any missing, inaccurate, or conflicting information.  Establish and enforce regular audit schedules.

Hourly Range: $32/hr - $34/hr (DOE)

Schedule: (Remote) Ideally 8:30am - 5:00pm in your respective time zone; however, the hours are flexible

Travel: Optional travel 3xs/year to Plano, TX where the team gets together for in-person collaboration but is not mandatory

Essential Duties and Responsibilities

Include the following. Other duties may be assigned, as necessary.

• Evaluates areas of risk to be addressed by each audit. Interprets the relative significance of issues needing resolution; escalates at an appropriate time.
• Conduct scheduled and non-scheduled compliance audits according to the audit plan while testing compliance with appropriate federal, state, and local regulations and standards, and internal policies and procedures.
• Performs risk assessments to identify compliance and non-compliance concerns.
• Implements on-going compliance audits by creating and enhancing audit tools relating to audit/monitoring activities and/or researching and investigating issues
• Prepare audit reports based on audit findings.
• Participates in management meetings to review audit findings and communication areas of concern or risk.
• Reviews management responses to determine if recommendations have been satisfactorily addressed. Addresses responses requiring further clarification or support.
• Develops and maintains current knowledge of laws, regulations, and market changes that impact all aspects of the Company, including, but not limited to, Contractual obligations, Federal and State compliance regulations.
• Establish and enforce regular audit schedules.
• Utilizes the 5 C’s of audits: criteria, condition, cause, consequence, and corrective action

• Comply with the Company’s Core Values and Core Competencies
• Perform other duties as assigned by supervisor

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Previous auditing experience.
• Strong communication, interpersonal, and presentation skills, working with both internal and external individuals and entities
• Strong ability to self-motivate.
• Excellent analytical problem-solving skills.
• Strong computer skills with proficiency in Microsoft Office
• Maintains discretion and safeguards confidential information
• Ability to work effectively with colleagues as team members and to communicate effectively.
• Excellent verbal and written communication skills.
• Strong customer service orientation.

Education and/or Experience

• 3--5 years' experience in auditing Home Infusion and/or Specialty Pharmacy billing and collection requirements as they align with all federal, state, and commercial payer guidelines.
• Experience with CPR+ and/or CareTend preferred but not required.
• Proficient with home infusion specialty pharmacy revenue cycle billing and collection best practices.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or listen. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle, or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR252198