Top 14 Healthcare auditor Jobs in Boston Ma

Pharmacy Network Auditor
RxSense —Boston, MA
- $74,000 - $110,000 a year
- Remote
- Microsoft Word
- 5 years
- Research
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6d
Coding and Compliance Auditor
South Shore Health —Weymouth, MA
- $73,000 - $104,400 a year
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Acute care experience
Clinical Audit Response Specialist
Dana-Farber Cancer Institute —Boston, MA
- $110,200 - $122,300 a year
- Full-time
- Nursing
- RN License
- 5 years
Sr. Audit Specialist
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $89,460 - $109,340 a year
- Full-time
- Microsoft Excel
- Office
- High school diploma or GED
- Health insurance
- Dental insurance
5d
HIM Audit Coordinator
Beth Israel Lahey Health —Burlington, MA
- $20.00 - $26.92 an hour
- Full-time
- Microsoft Word
- Nursing
- Anatomy knowledge
Assistant System Controller
Boston Medical Center —Boston, MA
- $122,000 - $177,000 a year
- Full-time
- CPA
- 5 years
- ERP systems
- Health insurance
- Dental insurance
Accounting Assistant
Greater Lawrence Family Health Center —Methuen, MA
- Internal Medicine
- Office
- High school diploma or GED
- Tuition reimbursement
Quick Apply
Lead Health Information Management Audit Specialist (On-Site)
Beth Israel Lahey Health —Burlington, MA
- $21.00 - $28.26 an hour
- Full-time
- Nursing
- Anatomy knowledge
- Microsoft Excel
Senior Accountant
Beth Israel Lahey Health —Charlestown, MA
- $68,640 - $114,712 a year
- Full-time
- Microsoft Outlook
- Hospital
- Customer service

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Coding and Compliance Auditor
South Shore Health —Weymouth, MA
Revises/modifies any instructional tools as necessary based on any changes to State and Federal regulatory changes to ensure guidance and training are accurate.
$73,000 - $104,400 a year
Coding Compliance Analyst
Optum —Worcester, MA
Develops and implement clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or…
$23.89 - $42.69 an hour

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340B Auditor
Bon Secours Mercy Health —Columbus, OH
Preferred Education : 2 Year Degree in Business, Information Technology/Analytics, Pharmacy, or related field. Assists with 340B external audits as assigned.
7d
External Auditor 2
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Conducting audits and reviews of Medicaid enrolled…
$31.47 an hour
13d

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healthcare auditor jobs near boston ma

Pharmacy Network Auditor

RxSense -
Boston, MA

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Job Details

$74,000 - $110,000 a year
6 days ago

Qualifications

Performance Reporting

Full Job Description

We are a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits. Our technology helps enterprise and partnership clients simplify their businesses and helps consumers save on prescriptions.

As a leader in SaaS technology for healthcare, we offer innovative solutions with integrated intelligence on a single enterprise platform that connects the pharmacy ecosystem. With our expertise and modern, modular platform, our partners use real-time data to transform their business performance and optimize their innovative models in the marketplace.

Position Summary:

The Pharmacy Network Auditor is responsible for the maintenance and growth of the Pharmacy Network Audit program and processes at RxSense, including all internal pharmacy audits, and working closely with external
pharmacy audit vendors to ultimately detect, prevent and recover on Fraud Waste Abuse (FWA) occurrences.The Pharmacy Network Auditor is solely responsible for assuring compliance with client contract requirements,
pharmacy contractual compliance, and effectively communicating the program updates in real-time to leadership.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pharmacy Network Auditor evaluates, reports and monitors all aspects pertaining to Pharmacy Network Auditing services
The role will also serve as a subject matter expert within the Company regarding standard monitoring measures, auditing procedures, and best practices
Assess the risks outlined by audit vendor, perform appropriate audit procedures, and collaborate with pharmacy management to resolve issues in a timely and efficient manner
Draft and communicate audit findings and observations to internal stakeholders such as Finance and Client Success; Provide Quarterly Network Audit Performance Reports to the leadership to monitor Audit Program efficacy
Screen and summarize authorized vendor audit results in detail prior to initiating claim adjustments
Review results to determine details of fraudulent, erroneous, or abusive billing activity
Responsible for leveraging current BI Tools to analyze claims data for potential investigational FWA breaches of network pharmacies
Maintain audit documentation, and prepare statistical data for internal stakeholder review and action
Develops and updates Standard Operating Procedures (SOPs) for audit and FWA Programs
Collaborates with key stakeholders to support pharmacy network initiatives
Establish and maintain relationships with Implementations, Client Services, Benefit Administration, UAT/QA, IT, Product, Finance, Clinical Departments with focus on actively engaging the appropriate teams to enhance the Audit/FWA program

Qualifications:

Previous Pharmacy Audit Experience is required, understanding of the processes and industry related guidelines are mandatory
5+ years of experience in a Retail Pharmacy setting and/or Pharmacy Benefits Management organization
Strong understanding of the pharmacy claims processing ecosystem
Strong understanding of pharmacy relationships and NCPDP data extracts
Proficient knowledge and ability to leverage current reporting tools to identify audit and FWA issues proactively
Strong understanding of Pharmacy Network Standards and how to manage potential FWA issues via claims data
Proficient knowledge of URAC and CMS network requirements in addition to Federal and State level auditing network requirements
Ability to research, analyze and report on audit results and industry trends in FWA
Proven ability to work independently and drive results
Detail-oriented, ability to multitask, proactive thinker
Excellent written and verbal communication skills
Experience with presenting and or training
Proficiency in MS Word and Excel

Salary Range: $74,000 - $110,000

RxSense believes that a diverse workforce is a more talented and productive workforce. As such, we are an Equal Opportunity and Affirmative Action employer. Our recruitment process is free from discriminatory hiring practices and all qualified applicants are considered for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Neither will qualified applicants be discriminated against on the basis of disability or protected veteran status. We believe in the strength of the collaboration, creativity and sense of community a diverse workforce brings.

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healthcare auditor jobs in boston ma

Pharmacy Network Auditor

Coding and Compliance Auditor

Clinical Audit Response Specialist

Sr. Audit Specialist

HIM Audit Coordinator

Assistant System Controller

Accounting Assistant

Lead Health Information Management Audit Specialist (On-Site)

Senior Accountant

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