Fraud analyst entry level jobs - 3 jobs

Serves as internal and external program coordinator and liaison for all 340B-related matters. Provides accurate execution of the 340B program Reports to: Director of Pharmacy Supervises: N/A Dress Requirement: Business casual Work Schedule: Full-Time Monday through Friday during standard business hours Times are subject to change due to business necessity Non-Exempt Job Duties, these are considered essential to the successful performance of this position: Key Responsibilities Serves as the organization “compliance expert or authority” on 340B regarding program details, policies, and procedures of the virtual inventory processes required for mixed-use areas. Serves as internal liaison to key stakeholders to help ensure appropriate utilization of the 340B Program and compliance with all program requirements. Acts as the liaison with necessary affiliated departments to ensure 340B Program integrity. Assist the organization's 340B oversight team, which includes representation from pharmacy, finance, and senior administration. Provides expertise with the 340B Program to staff and participants regarding ongoing compliance. Assists organizational leadership to develop a regular compliance audit program. Assist in developing processes and materials to promote programs or support the goals of the organization. Assist with the organization education, training, awareness, and customer service for all 340B covered entities May assist in the development, implementation, or promotion of programmatic resources/tools to support staff. Regularly communicates with all staff involved with the 340B Program to be sure that processes remain efficient and to address any problems or suggestions for improvement. Establishes a clear way for staff to communicate concerns to the coordinator. Develops, executes, and documents self-audits of the 340B process. Coordinates and ensures remediation of findings. Conducts and/or coordinates an annual audit of all contract pharmacies. Documents results and follow- up on any findings. Conducts monthly audits of all 340B-eligible locations to verify adherence with the 340B Program guidelines and policies. Prepares and assists in the monitoring and various tracking and reporting measurements to ensure compliance with the program. Reviews and refines 340B cost savings reports detailing purchasing and replacement practices, as well as dispensing patterns. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Facility Environment: Heart of Ohio Family Health operates in multiple locations, in the Columbus, OH area. All facilities have a medical office environment with front-desk reception area, separate patient examination rooms, nursing stations, pharmacy stock room, business offices, hallways and private toilet facilities. All clinical facilities are ADA compliant. This position's primary work area is in an office within our facility The office area is: kept at a normal working temperature sanitized daily maintains standard office environment furniture with adjustable chairs maintains standard office equipment; i.e., computer, copier, fax machine, etc. at a normal working height Physical Demands and Requirements: these may be modified to accurately perform the essential functions of the position: Mobility = ability to easily move without assistance Bending = occasional bending from the waist and knees Reaching = occasional reaching no higher than normal arm stretch Lifting/Carry = ability to lift and carry a normal stack of documents and/or files Pushing/Pulling = ability to push or pull a normal office environment Dexterity = ability to handle and/or grasp, use a keyboard, calculator, and other office equipment accurately and quickly Hearing = ability to accurately hear and react to the normal tone of a person's voice Visual = ability to safely and accurately see and react to factors and objects in a normal setting Speaking = ability to pronounce words clearly to be understood by another individual Qualifications Job Qualifications (Experience, Knowledge, Skills and Abilities) Certified or Registered Pharmacy Technician, preferred Preferred high school diploma Willingness to work with all cultural and socioeconomic groups without judgment or bias Demonstrates ability to cooperatively work/mediate with all age groups and family groups Compliance with the HIPAA law and regulation; ability to confidentially retain information, passing only necessary information to those needed to perform their duty Ability to work with minimal supervision and exercise sound independent judgment Excellent familiarity and application with medical terminology

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Position Purpose: Perform review of high dollar claims. Review for appropriate place of service, accurate coding, length of stay, match to authorization, and possible outlier DRG or Stop Loss pricing. Perform coding research. Conduct complex business and operational analyses to assure payments are in compliance with contract; identify areas for improvement and clarification for better operational efficiency resulting in better initiative, contract, and benefit implementation as well as better maintenance long term. Perform review of high dollar claims for benefit and pricing determination. Work collaboratively with Finance Department to determine appropriateness of pricing. Work collaboratively with Medical Management Department to resolve any issues with medical review notes that affect claim pricing Serve as a technical resource / coding subject matter expert for contract pricing related issues Responsible for entire cycle of facility claims which includes verifying information on submitted claims, reviewing contracts, eligibility, and authorizations to determine reimbursement, and ensuring payment instructions are sent to claims department for claims payment Identify key elements and processing requirements based on diagnosis, provider, contracts and policies and procedures utilizing broad based product or system knowledge to ensure timely payments are generated. Conduct point of service review and resolution of high dollar claims that are pending and/or adjusted incorrectly including review, investigation, adjustment and resolution of claims, claims appeals, inquiries, and inaccuracies in payment of claims. Collaborate with all departments to analyze complex claims issues and special claim projects. Qualifications Healthcare experience REQUIRED Managed Care strongly PREFERRED Associate's degree in Business, Health Care Management, Insurance, Healthcare or related field 3+ years of Medical Billing or Physician's office experience. Extensive knowledge of coding and billing practices for hospitals, physicians and/or ancillary providers as well as knowledge about contracting, claims processing, and provider customer service. Accepted Licenses/Certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Professional Coder-Payer (CPC-P) certification, Certified Professional Coder (CPC) Additional Information Shfit: Monday- Friday; 8AM-5PM Salary: $41,000-$46,000 + 6% Annual Bonus + Medical Benefits take effect 30 days after start date