Program Auditor Pharmacy
Program Auditor Pharmacy
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$ 21 - 30
1 Vacancy
Job Description
Location:
Worker Type:
RegularWork Shift:
Day Shift (United States of America)Pay Range:
The pay range for this position is listed below. Actual pay rate dependent upon experience.
$21.25 $30.75Position Highlights
You Belong at Avera
Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.
A Brief Overview
Responsible for reviewing retail prescriptions that qualified for the hospitals 340B Drug Pricing Contract Pharmacy Program. This role is required to review all eligible prescriptions and check eligibility against the hospitals electronic medical record for appropriate matching documentation and make corrections within the pharmacys reprocessing window and provide regular feedback to the leadership of Pharmacy Business & Analytics on auditing trends.
What you will do
- Review analyze and determine eligibility of contract pharmacy claims by investigating patient records in hospital EMR to ensure each prescription meets the 340B patient definition.
- Reverse ineligible claims within pharmacy reprocessing window.
- Communicate audit results with the Pharmacy Business & Analytics Team External 340B Software Vendor Contract Pharmacies Avera 340B Steering Committee and Avera Corporate Compliance Committee.
- Document all requested reversals and ensure reversals occur Maintain accurate provider file for hospitals assigned to.
- Remain current with 340B patient definition and current federal auditing guidelines and best practices.
- Monitor and report trending of third party contract pharmacy audits to Director of Pharmacy Business & Analytics Avera 340B Steering Committee and Avera Corporate Compliance Committee.
Essential Qualifications
The individual must be able to work the hours specified. To perform this job successfully an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others hear understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.
Required Education License/Certification or Work Experience:
- Associates or certified pharmacy technician. or
- Certified Pharmacy Technician (CPhT) Pharmacy Technician Certification Board (PTCB) Certified as a pharmacy technician by the Pharmacy Technician Certification Board (PTCB) Upon Hire
- 13 years experience within a hospital business office medical related field health plan third party administrator or managed care industry
Expectations and Standards
- Commitment to the daily application of Averas mission vision core values and social principles to serve patients their families and our community.
- Promote Averas values of compassion hospitality and stewardship.
- Uphold Averas standards of Communication Attitude Responsiveness and Engagement (CARE) with enthusiasm and sincerity.
- Maintain confidentiality.
- Work effectively in a team environment coordinating work flow with other team members and ensuring a productive and efficient environment.
- Comply with safety principles laws regulations and standards associated with but not limited to CMS The Joint Commission DHHS and OSHA if applicable.
Benefits You Need & Then Some
Avera is proud to offer a wide range of benefits to qualifying parttime and fulltime employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.
PTO available day 1 for eligible hires.
Free health insurance options for fulltime single coverage on Avera High Deductible Health Plan
Up to 5 employer matching contribution for retirement
Career development guided by handson training and mentorship
Avera is an Equal Opportunity Employer Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please callor send an email to .
Employment Type
Full-Time
