Compunnel
Ambulatory Regulatory Tech
Compunnel, Phila, Pennsylvania, United States, 19117
Job Summary:
The Ambulatory Regulatory Technician is responsible for managing internal and external pharmacy payer audits and requirements in accordance with Federal, State, and Internal auditing standards. This role supports the day-to-day activities of outpatient pharmacy locations, including insurance audit requests, proactive audits, and regulatory compliance. The technician services over 6 retail pharmacy locations in Philadelphia and suburban areas, compiling data for fax or electronic audits, supporting managers during in-person audits, and ensuring regulatory requirements are met.
Key Responsibilities:
• Conduct desktop and onsite audits for HUP Pharmacies in accordance with Federal, State, and Internal Audit standards.
• Proactively audit claims to ensure the appropriateness and accuracy of submitted pharmacy claims.
• Handle third-party requests in coordination with Pharmacy Managers.
• Audit delivery processes to ensure medications are delivered and receipts are on record.
• Assess risks in pharmacy audit assignments, perform appropriate audit procedures, draft and communicate audit findings and observations, and collaborate with pharmacy management to resolve issues.
• Assist with ongoing regulatory compliance and accreditation surveys, and monitor compliance with billing practices and collection of copays.
• Lead meetings in conjunction with management and perform quality assurance checks of pharmacy payer documentation to ensure accuracy and completeness.
• Complete payer regulatory requirements.
• Perform duties in accordance with Penn Medicine and entity values, policies, and procedures.
• Other duties as assigned to support the unit, department, entity, and health system organization.
Certification:
Certified Pharmacy Technician (CPhT)
The Ambulatory Regulatory Technician is responsible for managing internal and external pharmacy payer audits and requirements in accordance with Federal, State, and Internal auditing standards. This role supports the day-to-day activities of outpatient pharmacy locations, including insurance audit requests, proactive audits, and regulatory compliance. The technician services over 6 retail pharmacy locations in Philadelphia and suburban areas, compiling data for fax or electronic audits, supporting managers during in-person audits, and ensuring regulatory requirements are met.
Key Responsibilities:
• Conduct desktop and onsite audits for HUP Pharmacies in accordance with Federal, State, and Internal Audit standards.
• Proactively audit claims to ensure the appropriateness and accuracy of submitted pharmacy claims.
• Handle third-party requests in coordination with Pharmacy Managers.
• Audit delivery processes to ensure medications are delivered and receipts are on record.
• Assess risks in pharmacy audit assignments, perform appropriate audit procedures, draft and communicate audit findings and observations, and collaborate with pharmacy management to resolve issues.
• Assist with ongoing regulatory compliance and accreditation surveys, and monitor compliance with billing practices and collection of copays.
• Lead meetings in conjunction with management and perform quality assurance checks of pharmacy payer documentation to ensure accuracy and completeness.
• Complete payer regulatory requirements.
• Perform duties in accordance with Penn Medicine and entity values, policies, and procedures.
• Other duties as assigned to support the unit, department, entity, and health system organization.
Certification:
Certified Pharmacy Technician (CPhT)