Program Integrity Auditor
Location:
Avera McKennan HospitalWorker 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.
$22.75 - $32.75Position 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 hospital's 340B Drug Pricing Contract Pharmacy Program. This role is required to review all eligible prescriptions and check eligibility against the hospital's electronic medical record for appropriate matching documentation and make corrections within the pharmacy's 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 hospital's 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.
- Associate's 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
- 1-3 years experience within a hospital business office, medical related field, health plan, third party administrator, or managed care industry
- Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
- Promote Avera’s values of compassion, hospitality, and stewardship.
- Uphold Avera’s 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 part-time and full-time 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.
Up to 5% employer matching contribution for retirement
Career development guided by hands-on 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 call 1-605-504-4444 or send an email to [email protected].
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