Description
Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA
The Pharmacy Configuration Auditor is responsible for all audit activities in relation to Health Plans Pharmacy system configuration to create, maintain and provide statistical audit reports and documentation. This position is responsible for working independently to audit configuration in multiple pharmacy systems in areas of contracts, fee schedules, benefits, provider/vendor additions or changes, rules, code editing, etc. This position is not responsible for providing care to patients.
Corporate Overview:
University of Utah Healthcare is an integrated academic healthcare system with four hospitals including a level 1 trauma center, twelve community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University Healthcare is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million.
Responsibilities
* Performs audits on various pharmacy systems (retail and medical) to identify build issues, adherence to policies and procedures and documentation.
* Prepares reports for management summarizing observations and recommendations.
* Uses analytical data to determine trends and changes to data.
* Assists in quality improvement by providing information on trends and areas of concern.
* Develops and presents recommendations for a course of action based on the analysis of data.
* Makes recommendations for process improvements and supports their implementation.
* Develops and utilizes auditing template.
* Provides back up to Pharmacy Managed Care analyst as needed.
* Monitors system-programming configuration via JIRA tickets and other tools, to ensure changes are documented and implemented accurately.
* Evaluates data processing systems and operating procedures in accordance with corporate standards for efficiency, accuracy, and security.
* Completes financial analysis of incorrect system builds and makes recommendations for improvement/correction.
* Develops a thorough understanding of data sources used within the department, including how the data is obtained/stored, appropriate use of data from different information sources, complexities involved with certain types of data, and how to validate different types of data.
* Handles special projects and creates special reports as needed.
Knowledge / Skills / Abilities
* Demonstrated potential ability to perform the essential functions as outlined above.
* Excellent written and oral communication skills.
* Detail oriented and organized.
* Computer skills including Word, Excel, PowerPoint and Access.
* Ability to multitask and prioritize, as well as being flexible and adaptable.
* Ability to perform well in team environment with staff at all levels, in order to achieve business goals.
* Ability to perform calculations, problem solve and use reasoning.
* Ability to work independently to conduct research and resolve problems.
* Demonstrated prior experience with data transmission helpful.
* Demonstrated prior experience with medical coding and terminology.
Qualifications
Qualifications
Required
* Bachelor's degree in Information Systems, or the equivalency.
* Three years of experience collecting, organizing and maintaining health insurance and processing medical claims, enrollment, and familiarity with medical coding, or experience as a medical claim processor.
* Two years of experience in system configuration in the health insurance industry.
Qualifications (Preferred)
Preferred
* Experience in Pharmacy claim/benefit auditing (medical and/or retail pharmacy).
* Epic experience in Tapestry Benefits Engine, Tapestry Core, Tapestry UM and CM and Tapestry AP Claims and/or Contracts.
* Relay Health experience.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
* This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.
We are University of Utah Health. Employment.utah.edu
Immediately Hiring
Physical Requirements
Listening, Speaking
