GENERAL PURPOSE OF THE JOB
This position responds to, reviews, processes, and tracks payor audit requests and ensures requests are complete and submitted within the payor deadlines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive.
· Research and respond to payor audit requests
o Request extensions in deadlines
o Update tracking data base for changes, additions and completed audits
o Contact Payor for clarification of information requested
o Prepare refund audit response and related documentation for approval prior to submission
o Evaluate actions taken in each step of the prescription fulfillment process to identify breakdowns in process; recommend process changes to prevent reoccurrences
· Answer inbound calls from insurance Auditors
· Stay current on payor provider publication focused audit processes and changes
· Prepare appeals to respond to discrepant claims when applicable
· Other duites and responsibilities as assigned including but not limited to:
o Work overtime with little or no notice as needed
o Attend team meetings, phone conferences, and trainings as needed
o Know, understand, and follow teammate guidelines, employment policies, and department or company procedures
· Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
(Education, licenses, certifications, and experience required to fulfill the essential duties, include computer skills as required):
· High school diploma or equivalent required
· Associate’s or Bachelor’s degree in related area or Certified Pharmacy Technician preferred
· Minimum of two(2) years’ experience in pharmacy operations required OR
· Minimum of two(2) years’ billing, collections, and cash posting experience in healthcare or insurance required demonstrating:
o Knowledge of adjustments, payor remittances, recoups, and refunds
o Knowledge of billing claims analysis required
o Knowledge of basic accounting principles preferred
· Intermediate computer skills and proficiency in MS Word and Outlook required; advanced proficiency in MS Excel required
WARNING: Job Recruitment Scam Notice
Please note that DaVita Careers has been made aware of a phishing, job recruitment scam in which third parties are fraudulently representing themselves as recruiters of our company. These scammers are posting fake DaVita job openings and communicating with job candidates in an effort to obtain personal information and money. Please follow link to learn more about this scam.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
DaVita will consider qualified applicants who have criminal histories in a manner consistent with the law.