Payer Audit Specialist

PharMerica•Vancouver, WA

3d•$20 - $21

About The Position

The Payer Audit Specialist receives and processes commercial and government payer audit requests for select PharMerica locations. The role reviews audit requests, compiles and classifies existing documentation, identifies medical documentation needed for responses, and performs quality assurance checks of medical and billing documentation before submission. The specialist reports missing items, issues, or trends to the Revenue Cycle Management (RCM) Ancillary Services management team or General Manager. The position requires analytical, prioritization, problem-solving, and multitasking abilities, along with exceptional internal and external customer service and support for PharMerica’s company culture. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Pacific Time. The salary range is $20.00–$21.00 per hour. PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through local teams serving skilled nursing facilities, senior living communities, hospitals, and individuals with behavioral, infusion therapy, in-home care, and cancer-related needs. Its long-term care, home infusion, and specialty pharmacies operate nationwide, combining local service with national resources, technology, and regulatory expertise.

Requirements

High school diploma, GED, or equivalent required.
Two to four years of revenue cycle management experience, with a 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 40+ WPM.
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.

Nice To Haves

Some college education.
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.
Follow applicable state and federal regulations and company policies.
Receive, document, process, and track payer audit requests and updates through final resolution.
Coordinate across departments to ensure audits receive appropriate review, appeals, and resolution.
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 promptly 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.