Schedule: Mon-Fri, 8am-5pm
Assists the Health & Wellness Department in responding to third party audit requests and investigations by assisting management in verifying details of billing and claims for third party payers; validating the use of appropriate processes and procedures; gathering and reviewing audit data; tracking audit requests throughout the various audit stages; and capture discrepancy and recoupment data for monthly reporting to the pharmacy, operations, compliance, and payer relations.
Identifies and monitors past, present, and future risks by assisting management in the audit of H&W groups under review; translating audit findings into recommendations; and ensuring document request deadlines are met.
Monitors new, voluntary, and corrective action plans by assisting management in conducting follow up post-audit to ensure corrective action is taken; participating in the assessment of the effectiveness of actions; and reporting the findings to the Audit Managers. Auditor may manage and assign audit requests received daily.
Completes work assignments in Health and Wellness Audit by using policies, data, and resources; collaborating with managers, coworkers, customers, and other business partners; identifying priorities, deadlines, and expectations; carrying out tasks; communicating progress and information; determining and recommending ways to address improvement opportunities within the team; and adapting to and learning from change, difficulties, and feedback.
Complies with company policies, procedures, standards of ethics, and integrity by implementing related action plans; using the Open Door policy, and applying these in executing business processes and practices.
Close attention to accuracy and detail; excellent follow up skills; basic Windows; intermediate Excel, Word, and Microsoft Outlook skills; excellent math skills; excellent customer service skills; ability to work in a team environment; willingness to learn; highly detailed and organized; fast learner; ability to meet deadlines; comfortable in a fast paced, ever-changing environment
High School graduate or GED