Program Integrity Auditor

Job description

Location: Avera McKennan Hospital Worker Type: Regular Work 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 - $32.75 Position 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 B...