The Payer Audit Specialist receives and processes commercial and government payer audit requests for select Pharmerica locations. The Payer Audit Specialist reviews audit requests, compiles and classifies existing documentation, and identifies medical documentation needed to respond effectively and efficiently to these requests. The Payer Audit Specialist performs quality assurance checks of all medical and billing documentation before submission and notifies the Revenue Cycle Management (RCM) Ancillary Services management team or General Manager of any missing items, issues, or trends. The employee must have the ability to analyze, prioritize, problem solve, and multi-task. Above all, qualified candidates should possess exceptional internal and external customer service skills and actively promote Pharmerica’s company culture.

Schedule:
Monday - Friday
8 am -4:30 pm PST

• Competitive Pay 

• Health, Dental, Vision & Life Insurance

• Company-Paid Short & Long-Term Disability
• Flexible Schedules & Paid Time Off
• Tuition Reimbursement 
• Employee Discount Program & DailyPay
• 401k

• Pet Insurance

• Ensures daily accomplishments by working toward individual and company goals for cash collections, payer audits, credit balances, medical records, correspondence, appeals/disputes, accounts receivable over 90 days, and other departmental goals
• Understands and adheres to all applicable state/federal regulations and company policies
• Receives, documents, processes, and tracks all incoming payer audit requests and updates until final resolution is obtained
• Communicates and coordinates across departments to ensure audits receive the proper review, appeals, and resolution
• Coordinates with other departments to obtain documentation and justification for medical services rendered. Assembles documentation, composes appeal responses, and submits back to payers in the required format.
• Responds timely to all payer audit requests and submits responses within payer deadlines
• Analyzes payer audit trends and communicates concerns and process improvement needs to the RCM Ancillary Services management team
• Works within established departmental goals and performance/productivity metrics

• High School diploma/GED or equivalent required; some college a plus
• A minimum of two to four years of experience in revenue cycle management with a strong working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement; audit experience a plus
• Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus
• Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, CPT, HCPCS coding, and medical terminology
• Solid Microsoft Office skills with the ability to type 40+ WPM
• Strong verbal and written communication skills with the ability to independently obtain and interpret information and compose written audit responses
• Strong attention to detail and ability to be flexible and adapt to workflow volumes
• Knowledge of federal and state regulations as it pertains to revenue cycle management, a plus
• Flexible schedule with the ability to work evenings, weekends, and holidays as needed

At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing by leading with integrity, accountability, and transparency in all that we do.

As part of our hiring process, we may use third-party artificial intelligence (AI) tools to assist in processing employment-related information. These tools are used to support our recruitment activities and are subject to human oversight and review. BrightSpring does not use AI to make employment decisions independently, and AI is not used to discriminate against applicants or employees. We do not use zip codes as a proxy for protected characteristics. All hiring decisions are made by people, including our recruiters and hiring leaders.

BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities. If you need a reasonable accommodation during the application or hiring process, please contact your recruiter or email TalentAcquisition@brightspringhealth.com. For additional information about how our company uses AI in the hiring process, please contact TalentAcquisition@brightspringhealth.com.

BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

If you have a disability and are unable to use our online tools to search or apply for jobs, we would like to assist.  Please contact us for accommodation assistance.

Equal Opportunity Employment Posters

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