<span>Pharmacy Claims Medicare Audit Specialist (Hybrid Work Schedule)</span>

Kroger • Hutchinson, KS

398d

About The Position

The Pharmacy Claims Medicare Audit Specialist is responsible for researching Medicare claims audits submitted by third-party agencies, ensuring compliance with strict deadlines. This role involves communicating findings to various stakeholders, tracking recouped claims, and creating process improvement documents to enhance pharmacy operations. The specialist will demonstrate the company's core values while maintaining confidentiality and accuracy in all tasks.

Requirements

• Self-starting and able to perform job responsibilities with minimal supervision.
• Physical ability to access all necessary files.
• Highly organized and detail-oriented, able to function effectively in a multi-task environment.
• Ability to work within strict deadlines.
• Ability to use discretion and maintain confidential information.
• Strong analytical skills.
• Good written and verbal communication and customer service skills.
• Working knowledge of Microsoft Office, including Excel.

Nice To Haves

• Basic insurance knowledge and Medicare/Medicaid knowledge.
• Knowledge of third-party operations and accounts receivable.
• Knowledge of Pharmacy store systems (EasyFill PRN).

Responsibilities

• Research Medicare claims audits sent to the company by third-party agencies within strict deadlines.
• Communicate findings with divisions, pharmacies, and nurse reviewers to reduce the number of claims recouped from the company.
• Create Process Improvement Documents for pharmacies.
• Track recouped claims through the pharmacy receivables system to ensure accurate accounting and write-off.
• Maintain all incoming notices, original audit balances, final results, ending recoupment activity, and discrepancy codes for assigned audits.
• Enter all audit information into the pharmacy accounting system for reporting and tracking.
• Coordinate education calls with nurse reviewers to address audit denials and negotiate final financial results.
• Ensure audit deadlines are met and stores comply with audit notices.
• Request medical records and/or proof of due diligence.
• Provide timely and accurate communication of information and accounting to the divisions regarding audit loss.

What This Job Offers

• Job Type: Full-time
• Industry: Food and Beverage Retailers
• Education Level: No Education Listed