Payer Audit Specialist

BrightSpring Health Services•Vancouver, WA

About The Position

The Payer Audit Specialist receives and processes commercial and government payer audit requests for select PharMerica locations. The role reviews requests, compiles and classifies existing documentation, and identifies medical documentation needed to respond effectively and efficiently. It performs quality assurance checks on medical and billing documentation before submission and notifies the Revenue Cycle Management (RCM) Ancillary Services management team or General Manager about missing items, issues, or trends. The position requires the ability to analyze, prioritize, problem solve, and multitask, as well as exceptional internal and external customer service and active promotion of PharMerica’s company culture. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. PST, with flexibility to work evenings, weekends, and holidays as needed. The salary range is $20.00–$21.00 per hour.

Requirements

High school diploma, GED, or equivalent required.
Two to four years of experience in revenue cycle management.
Strong working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement.
Working knowledge of automated billing systems.
Working knowledge and application of metric measurements, basic accounting practices, ICD-9/10, CPT, HCPCS coding, and medical terminology.
Solid Microsoft Office skills and ability to type at least 40 words per minute.
Strong verbal and written communication skills, including 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.
Ability to work a flexible schedule, including evenings, weekends, and holidays as needed.
Ability to analyze, prioritize, problem solve, and multitask.
Exceptional internal and external customer service skills.

Nice To Haves

Some college.
Payer audit experience.
Experience with CPR+ and Waystar.
Knowledge of federal and state regulations as they pertain to revenue cycle management.

Responsibilities

Work toward individual and company goals for cash collections, payer audits, credit balances, medical records, correspondence, appeals and disputes, accounts receivable over 90 days, and other departmental goals.
Adhere to applicable state and federal regulations and company policies.
Receive, document, process, and track incoming payer audit requests and updates through final resolution.
Communicate and coordinate across departments to ensure audits receive appropriate review, appeals, and resolution.
Coordinate with other departments to obtain documentation and justification for medical services rendered.
Assemble documentation, compose appeal responses, and submit responses to payers in the required format.
Respond to payer audit requests in a timely manner and submit responses within payer deadlines.
Analyze payer audit trends and communicate concerns and process-improvement needs to the RCM Ancillary Services management team.
Work within established departmental goals and performance and productivity metrics.
Perform quality assurance checks of medical and billing documentation before submission.
Notify the RCM Ancillary Services management team or General Manager about missing items, issues, or trends.