POSITION DESCRIPTION
JOB TITLE: Associate –Pharmacy Accuracy, Rx Units Audit
DEPARTMENT: Operations
REPORTS TO: Manager - Operations
PRINCIPLE PURPOSE OF JOB
The Specialist, Payment Accuracy position is an entry level position responsible for auditing client data and generating high quality recoverable claims for the benefit of Connolly and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information and conclusions drawn to support the work performed so other reviewers may validate claim. Communicates audit recommendations to supervisory auditor for evaluation, verification and continuous learning.
JOB RESPONSIBILITIES
- Identifies and Enters Claims
- Under direct supervision, audits standard reports and identifies over and under payments of claims. Scope may include: quality assurance; auditing paid claims; determining whether an overpayment exists; duplicate payments; identifying incorrect contract or contract rates; Coordination of Benefits; Data Mining; Medical Chart Review; Medical Necessity; Claims Adjudication. Enters the claim into Cotiviti system accurately and in accordance with standard procedures. Can work on some simple/medium standard audit reports with support.
- Effectively utilizes Audit Tools
- Utilizes with increasing proficiency, proprietary reports, tools and systems required to perform duties with moderate guidance and direction, timely executes assigned standard reports and updates. Working proficiency with all systems and applications including internal and client tools.
- Critical Thinker
- Demonstrates adeptness in identifying errors and exceptions that result in valid claims. Has an eye for irregularities. Ability to analyze data, identify inconsistencies and formulate workable solutions. Makes logical, well-reasoned and timely decisions.
- Initiative Taker
- Shows initiative and a willingness to engage in all areas of the audit. Reaches beyond current tasks to add value to audit team. Goes the extra step to solve problems instead of waiting for someone else to solve them. Successfully integrates and multi-tasks new assignments
- Technically Capable
- Demonstrates competency with tools of the job including but not limited to computers, word processing & spreadsheet applications, web systems, Cotiviti and Client systems, and data file structures. Can efficiently download and format common file types.
- Customer Centric
- Treats customers/clients both internal and external as number one priority, is committed to continuous quality improvement, is courteous and responsive to customer's needs, meets or exceeds all customer commitments and treats customers honestly.
- Delivers Results
- Produces and documents well written claims, consistent with high level of integrity. Claims can be easily understood by client and provider/supplier community. Consistently meets or exceed goals at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.
- Time Management
- Ensures timely completion of audit reports. Exhibit's an understanding of audit planning activities and uses a structured and dependable approach to accomplishing assigned work.
- Continuous Improvement
- Identify opportunities to improve the efficiency of standard report to reduce false positives, streamline the research process and strive to increase the ID per hour. May offer suggestions and recommendations for process improvement and efficiencies.
ATTRIBUTES AND BEHAVIORS
- Develops and maintains positive working relationships with others.
- Shares ideas and information.
- Assists colleagues unprompted.
- Takes pride in the achievement of team objectives.
- Has credibility with peers and managers.
- Self-motivated – driven to achieve results.
- Works with a sense of urgency.
- High customer service ethic – is passionate about meeting customer expectations and improving service levels.
- Keeps pace with change – acquires knowledge/skills as the business evolves.
- Handles confidential information with sensitivity.
- Exhibits behaviors consistent with Cotiviti Values:
- Integrity
- Our Clients
- Our Team
- Accountability
- Performance Excellence
- Continuous Improvement
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS
- At least one (1) year of relevant experience (auditing, claims, billing, reimbursement, data analysis)
- Pharmacy and or Bachelor’s degree preferred.
- Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred
- Strong interest in working with large data sets and various databases
- Healthcare industry experience desired
- Excellent verbal and written communication skills
- Self-motivated and driven to succeed
SKILLS & COMPETENCIES
- A solid understanding of data crunching, excel, client management acquired through prior work experience.
- Strong analytical, critical thinking and problem solving skills.
- Excellent verbal and written communication skills.
- Excel proficiency, Access proficiency will be an added advantage.
- Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads.
- Ability to work well independently and maintain focus on a topic for prolonged periods of time.
- Comfort in working with team members that are remote and located in the US, India or other geographies.
- Ability to work within a matrix organization.
- Experience with US clients and familiarity with process development is preferred.
- Should have worked on process mapping using tools like Visio, BRS and TRS.
- Should manage client and internal conference calls independently.
- Should be good on documentation to create BRS, TRS and overall process mapping.
JOB DEMANDS
- Occasional requirement to travel (primarily related to training and Company meetings) within the US.
- Flexibility to travel outside of the India based on business need preferred.
- Ability to work seated at a computer for long periods of time.
- Candidate should be ready to work in different shifts, including night shift.
KEY CONSTITUENTS
- Asst Manager, Team Leader.
- Works with all Cotiviti business teams but especially onshore (Analysts).
V 0.0.1