Shopko

About Shopko

 

Founded in 1962 and headquartered in Green Bay, Wisconsin, Shopko Stores Operating Co., LLC operates 363 stores in 24 states throughout the Central, Western and Pacific Northwest regions. Retail formats include 131 Shopko stores, providing quality name-brand merchandise, great values, pharmacy and optical services in small to mid-sized cities; 5 Shopko Express Rx stores, a convenient neighborhood drugstore concept; 5 Shopko Pharmacy locations; and 222 Shopko Hometown stores, a smaller concept store developed to meet the needs of smaller communities.

 

 

Country:

United States

Postal Code:

54229

Approximate Salary:

Not Specified

Third Party Audit Coordinator

Shopko - Green Bay, Wisconsin

Posted: 11/20/2018

External Job Posting

POSITION SUMMARY:
Evaluates and mitigates third party pharmacy audits and recoupment.  Analyzes root cause and works with pharmacies, prescribers, recovery services and third party payers to achieve favorable audit results.  Maintains audit reporting to include audit stages and at risk and final audit findings.  

DUTIES & RESPONSIBILITIES:
Documentation 
Identifies key root causes of Audits and work to reduce by educating the organization.
Ensures that the audit documentation is complete by gathering the appropriate documentation.  Also responsible for verifying the accuracy of any file documentation submitted by pharmacies for appropriate claims.
Works with prescriber’s offices to gather appropriate medical records for audits and verify accuracy when applicable.
Assembles and submit audits to Medicare Part B and other Third Party payers
Documents and tracks requests and results in Excel or other Third Party applications.
Reports on Total Risk, Preliminary Findings, and Final Recoupment.
Engages with Third Party Plans Auditors building relationships, challenging findings, and improving overall Audit Scores.
Maintains an understanding of Third Party Plan / ShopKo contractual terms related to Audits and work with VP of Managed Care to maintain repository file of language.

Pharmacy Claim Education
Ensures pharmacy teams are following proper Medicare Documentation Procedures.  Work with pharmacy teams who are falling short of Shopko standards
Drafts regular “Audit Tips” for weekly communication to pharmacies
Works with prescribers to educate them on necessary documentation requirements 
Develops new audit documentation policies and procedures and offer insights to improve current policies and procedures.  Work with the appropriate teams to implement updated policies and procedures.
Assists with updating Medicare compliance materials as regulations or audit focus changes
MINIMUM KNOWLEDGE, EXPERIENCE & SKILLS REQUIREMENTS:
High School Diploma
2+ Years Health Services Pharmacy Experience
2+ Years’ experience working with third party claims adjudication – particularly Medicare B
Exceptional attention to detail and organizational skills
Ability to communicate professionally and appropriately with internal and external parties
Excellent oral and written communication skills
Strong understanding of Microsoft Excel, and Word document. 

Company Overview
We provide general merchandise, Pharmacy, and Optical services in our store formats of Shopko, Shopko Hometown, and Shopko Express.   
 
At Shopko, we understand what matters to our customers.  Our stores are designed to be simple, clean, and welcoming, not overwhelming.  We offer the essentials our customers need and the brands they trust at a fair price.  Shopko, the Stuff that counts.
Shopko offers a professional team-oriented work environment, career advancement opportunities, competitive wages, and a comprehensive benefits package! If you are accessing this posting from another website, please submit an application at www.shopko.com/careers.
 
Shopko is an Equal Opportunity Employer functioning under an Affirmative Action Plan m/f/d/v.

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