Risevoic
Pbm Payer Audit Specialist / Remote
Company : Adoration Home Health & Hospice
Location : Centennial, CO
Job Type : Full Time
Date Posted : 1 January 2026
Our Company
Amerita
Overview
Providing service to all the Amerita locations, the PBM Payer Audit Specialist reviews audit request, compiles and classifies existing documentation and identifies documentation needed to respond effectively and efficiently. The PBM Payer Audit Specialist also performs quality assurance checks for all medical and PBM billing documentation before submission and notifies the RCM Ancillary Services management team or General Manager of any missing items, issues, or trends.
Schedule:Monday - Friday 7am-3:30pm MST
• Competitive Pay
• Health, Dental, Vision & Life Insurance
• Company-Paid Short & Long-Term Disability • Flexible Schedules & Paid Time Off• Tuition Reimbursement • Employee Discount Program & DailyPay• 401k
• Pet Insurance
Responsibilities
- Receives, documents, processes, and tracks all incoming PBM payer audit requests and updates until final resolution is obtained. Responsible for correcting PBM claim audit deficiencies and resubmitting claims back to the payer as needed
- Responsible for cross training and providing support to handle incoming payer medical audits
- Communicates and coordinates across departments to ensure audits receive the proper review, appeals, and resolution
- Coordinates with other departments to obtain documentation and justification for medical services rendered. Assembles documentation, composes appeal responses, and submits back to payers in the required format
- Responds timely to all PBM payer audit requests and submits responses within payer deadlines
- Analyzes PBM payer audit trends and communicates concerns and process improvement needs to the RCM Ancillary Services management team
- Records payer audit responses utilizing the appropriate subject headers and templates in CPR+ and the Payer Audit Tracking spreadsheet
- Utilizes most efficient resources to submit PBM payer audits, giving priority to electronic solutions
- Maintains CPR+ Document Management system to include faxing, scanning, and attaching documents
- Oversees the PBM Test Claim report and works to resolve rejected submissions to avoid erroneous payments
- Assists with pulling manufacturer invoices needed for PBM and medical audits
- Reviews PBM credit balances and works with payer to resolve through payer refunds or using Amerita’s approved adjustment codes
Qualifications
- Successful completion of an approved/accredited Pharmacy Technician training program strongly preferred
- 1-3 years of related pharmacy experience in a home care setting
- Basic pharmacy knowledge of reading and interpreting prescriptions and submitting pharmacy claims to PBM payers.
- Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus.
- Working knowledge and application of metric measurements, basic accounting practices, ICD 10, CPT, HCPCS coding, and medical terminology.
- Solid Microsoft Office skills with the ability to type 40+ WPM.
- Strong verbal and written communication skills with the ability to independently obtain and interpret information and compose written audit responses.
- Strong attention to detail and ability to be flexible and adapt to workflow volumes.
- Knowledge of federal and state regulations as it pertains to revenue cycle management, a plus.
About our Line of Business
Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com. Follow us on Facebook, LinkedIn, and X.Salary Range
USD $20.00 - $26.00 / Hour
Westminster, CO
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Frequently asked questions
This specialist ensures accurate review and submission of PBM payer audits, directly impacting claim approvals and reimbursement efficiency. Their expertise in pharmacy claims and audit documentation helps reduce payment errors and supports streamlined revenue cycle management in home health settings.
Strong attention to detail, proficiency with billing software like CPR+, and knowledge of pharmacy claims coding (ICD-10, CPT, HCPCS) are vital. Effective communication and the ability to manage audit timelines remotely also enhance performance in this specialized auditing role.
Common hurdles include coordinating documentation across departments, meeting strict payer deadlines, and resolving rejected claims efficiently. Remote settings require excellent organizational skills and tech-savviness to maintain audit tracking systems and submit appeals accurately.
While not mandatory, completing an accredited pharmacy technician program is highly favored locally. Such credentials can enhance understanding of prescriptions and pharmacy claims, aligning well with regional employer expectations in specialized infusion and home health care.
Centennial’s healthcare sector shows steady demand for billing and audit specialists, driven by growing home care services. Competition is moderate, with employers valuing candidates who combine pharmacy knowledge and remote audit experience to support efficient revenue cycles.
Adoration emphasizes comprehensive benefits including tuition reimbursement, pet insurance, and flexible schedules. Their affiliation with Amerita offers exposure to specialty infusion services, blending corporate resources with a local provider’s agility, which enriches the audit specialist's role.
The company invests in continuing education through tuition reimbursement and cross-training opportunities. Their collaborative environment encourages mastering medical and pharmacy auditing tools, helping specialists expand expertise within the revenue cycle management field.
The advertised pay spans $20.00 to $26.00 per hour, reflecting regional standards and the role’s specialized pharmacy audit demands. This competitive range balances experience, remote work flexibility, and the complexity of medical billing processes involved.
Collaboration is key, as the specialist coordinates with RCM management, medical billing, and ancillary services to ensure audit requests and appeals are properly handled. This cross-functional interaction supports accurate documentation and timely payer communications.
Expertise in CPR+ and familiarity with Waystar billing systems are advantageous. Additionally, strong Microsoft Office skills and document management capabilities, including scanning and faxing, are crucial to maintain organized audit submissions and tracking.