HealthTech Client #1 | Patient Advocacy Audit Specialist (PH)

On behalf of HealthTech Client #1, SD Solutions is looking for a talented Patient Advocacy Audit Specialist to join the team.

The Patient Advocacy Audit Specialist is a quality assurance role responsible for reviewing and auditing the work performed by Patient Advocates. This role ensures that patient advocacy tasks are completed accurately and in alignment with program requirements and client expectations, with a primary focus on identifying revenue recovery opportunities and surfacing actionable findings to leadership. The Audit Specialist does not perform patient-facing activities but instead serves as a quality control function supporting the Patient Advocacy team.

SD Solutions is a staffing company operating globally. Contact us to get more details about the benefits we offer.

Supporting audit responsibilities are centered on PAP and Copay program workflows, including reviewing completed enrollments, claims, and medication orders for accuracy and task completion. This includes evaluating whether correct rejection reason codes were applied, snooze protocols were followed appropriately, and tasks were completed within required timeframes. Auditors are expected to recognize common miss patterns — such as out-of-retro occurrences, premature closures, and snooze misuse — and flag these findings for Manager review.

Responsibilities:

MAP Rejection Code Review & Revenue Recovery.

• Review rejected tasks in MAP on a daily basis to verify that the correct rejection code was applied for each rejected task
• Identify rejection code errors where the underlying enrollment, order, or claim remains actionable and can still be captured — distinguishing miscoded rejections from true terminal rejections
• Surface identified rejection code errors directly to the Director of Patient Advocacy with sufficient detail for Managers to take immediate corrective action
• Prioritize findings with active recovery potential to minimize revenue leakage and enable advocates to re-engage eligible patients before program or prescription deadlines lapse
• Track patterns in rejection code misuse over time to identify training gaps or systemic coding errors within the advocate team

Continuous Improvement Identification

• Document and track quality findings to support identification of opportunities to improve patient advocacy workflows, tools, and services
• Prepare audit finding reports and submit structured feedback to the Director of Patient Advocacy
• Participate in calibration sessions to align audit standards with operational expectations

Requirements:

Education & Experience.

• High school diploma or equivalent required; associates degree or higher preferred
• Prior experience in a healthcare, patient access, billing, or quality assurance environment strongly preferred
• Familiarity with patient assistance programs, copay support, or pharmaceutical access programs is a plus
• Experience with healthcare Electronic Health Records (EHRs) such as EPIC, Cerner, Meditech, or Allscripts preferred

Technical Skills

• Proficient computer skills with advanced Microsoft Office capabilities (assessment may be administered)
• Ability to navigate multiple computer systems and platforms simultaneously
• Basic knowledge of medical terminology preferred
• Experience with audit tools, quality tracking systems, or case management platforms is a plus

Soft Skills & Attributes

• Exceptional attention to detail with a sharp eye for errors and inconsistencies
• Strong analytical and critical thinking skills
• Clear written and verbal communication skills for documenting and reporting findings
• Ability to work independently with minimal supervision in a remote environment
• Organizational discipline and ability to manage a high volume of audit cases
• Flexibility to adapt to evolving workflows, program changes, and shifting priorities

About the company:

A U.S. healthcare company whose mission centers on simplifying patient access to medical care and financial aid programs. The team connects patients with manufacturers' assistance programs and coordinates medication delivery, aiming to remove financial barriers to treatment.

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