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.
Top Skills
What We Do
CarepathRx is transforming pharmacy care delivery for health systems and hospitals, delivering improved patient outcomes that drive clinical, quality and financial results.
CarepathRx provides the industry’s most comprehensive hospital pharmacy care delivery model, providing support across the patient’s complete healthcare journey—across multiple care settings, from hospital to home, no matter the patient acuity level.
We take an enterprise approach to pharmacy care delivery, providing a powerful combination of technology, market-leading clinical pharmacy services, and wrap-around services. This comprehensive, end-to-end approach enables health systems and hospitals to optimize pharmacy performance across the entire enterprise, including:
- Fully integrated pharmacy operations
- Expanded healthcare services
- Improved ambulatory access
- Minimized clinical variation
- Enhanced clinical patient outcomes
- New revenue streams
- Optimized health system revenue growth
For patients this means a more seamless experience and better overall health. And for clients, it means pharmacy is no longer a cost center—it’s a results generator. Today, CarepathRx works with more than 15 health systems and 600 hospitals nationwide.
.jpg){kind=logo}
