Genoa Healthcare

Job Category:

Other

Country:

United States

Postal Code:

55120

Approximate Salary:

Not Specified

Position Type:

Full Time

Audit Specialist

Genoa Healthcare - Eagan, Minnesota

Posted: 10/13/2018

Overview

Genoa Healthcare, LLC. is the leading pharmacy and telepsychiatry provider serving the behavioral health and addiction treatment communities for over 15 years. We are a rapidly growing and successful organization with a nation-wide network of pharmacies and providers. We are guided by our CARE Values. What we do is more than just provide medicine. We change lives for the better. And on the best of days, we help people get their lives back. We love what we do. It’s a privilege. It’s a challenge. It matters.

 

The Audit Specialist will (1) review, track, and submit all 3rd party insurance audits and appeals; (2) conduct periodic internal claims audits.

Responsibilities

Major Duties & Responsibilities:

  • Oversee 3rd party insurance audits that are received from all pharmacy sites
  • Construct professional, well written audit appeals when necessary
  • Track and report audit deadlines and audit results
  • Work with pharmacy staff to obtain necessary information and documentation for audit requests
  • Maintain a record retention of all audit submissions
  • Communicate with the appropriate PBM/insurance auditor for appeal requirements (when needed)
  • Conduct internal compliance audits of claims and billing practices of Medicaid, Medicare and commercial insurance programs
  • Prepare reports of claims audit findings
  • Support the Compliance Officer and team as needed
  • Oversee the Audit e-mail inbox
Qualifications

Educational or Skills Requirements:

  • Bachelor’s Degree
  • Associates Degree with at least 2 years of similar job function experience
  • Minimum 3 years of pharmacy audit or relevant industry experience
  • Familiarity with pharmacy claims and billing requirements
  • Strong Excel and Outlook knowledge
  • Strong attention to detail
  • Basic SharePoint knowledge (preferred)
  • Ability to prioritize and meet multiple deadlines simultaneously
  • Ability to maintain professionalism and composure under stressful situations
  • Strong communication skills, both verbal and written

Ability to work independently with little to no supervision

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