CLAIMS ANALYST - 3RD PARTY
Our Company PharMerica OverviewJoin our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients.
We offer a non-retail pharmacy environment.
Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression! We offer the flexibility for this position to be on-site, a hybrid, or remote.
Applicants must reside a commutable distance to Taunton, MA Schedule:
Monday - Friday 8:
30AM-5PM EST We offer:
DailyPay Flexible schedules Competitive pay Shift differential Health, dental, vision and life insurance benefits Company paid STD and LTD Tuition Assistance Employee Discount Program 401k Paid-time off Tuition reimbursement Non-retail/Closed-door environment Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide.
If your passion is service excellence and top-quality care come join our team and apply today! Responsibilities Communicate effectively and professionally with 3rd party entities including Pharmacy Benefit Managers (PBM's), pharmacy claim switches, and other vendors regarding claim or plan inquiries.
Understand various payer requirements and configure billing parameters within proprietary software to send online transactions to and from 3rd party insurance payers in accordance with HIPAA named standards set forth by the National Council for Prescription Drug Programs (NCPDP) Review 3rd party payer sheets for specific configuration details.
Construct telecom standard field specific templates for each payer Communicate with Switching company to construct external pre and post claim edits to prevent claim denials and ensure proper reimbursement.
Send and receive contracts on behalf of the Director of 3rd Party Network Services.
Work with Compliance team to obtain, reissue, or renew Medicaid provider ID's, and work with other internal teams across the organization.
Serve as Subject Matter Expert (SME) on cross functional work groups Provide operational support and troubleshooting to resolve both internal and external inquiries.
Research and resolve complex billing issues with available resources and tools.
This includes researching both denied and paid claim transactions, understanding root cause for denied claims or under reimbursement on paid claims, implementing methods to reduce such claims, or educating pharmacies on prevention opportunities.
Ensure all industry and/or payer related changes are communicated throughout the organization o Independently and accurately manage workload in a timely manner with minimal direction.
Communicate when competing priorities cannot be managed independently.
Prepare recurring reports related to claim denials or payments.
Query, massage, and analyze small to medium sums of claim data.
Summarize and report findings to executive management or other internal teams Support project teams in the development of functional requirements Performs other tasks as assigned.
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed above are representative of the knowledge, skill, and/or ability required.
Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Qualifications HS Diploma, GED or equivalent experience is required 2
yrs experience as a Pharmacy Technician or in a billing position within a healthcare setting is required 1
yrs experience with pharmacy or health data analysis is required 1
yrs experience working in a Pharmacy, Long Term Care or Managed Care setting is required Excellent verbal and written communication skills needed Excellent time management skills; ability to work independently and manage multiple/competing priorities required Proven ability to work with a high degree of accuracy and attention to detail Proficient in all Microsoft Word and Outlook Demonstrated analytical skills, technical knowledge and creative problem solving techniques Ability to effectively navigate ambiguous situations with limited direction Advanced analytical skills with the ability to interpret and synthesize complex data sets Able to handle high volume and significant workload Query building experience through use of Microsoft Access or other proprietary systems is a preference Familiarity with long term care pharmacy or facility billing practices is a preference About our Line of Business PharMerica is a full-service pharmacy solution providing value beyond medication.
PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.
PharMerica is one of the nation's largest pharmacy companies.
PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades.
For more information about PharMerica, please visit www.
pharmerica.
com.
Follow us on Facebook, Twitter, and LinkedIn.
Recommended Skills Analytical Attention To Detail Billing Claim Processing Creative Problem Solving Data Analysis Estimated Salary: $20 to $28 per hour based on qualifications.
We offer a non-retail pharmacy environment.
Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression! We offer the flexibility for this position to be on-site, a hybrid, or remote.
Applicants must reside a commutable distance to Taunton, MA Schedule:
Monday - Friday 8:
30AM-5PM EST We offer:
DailyPay Flexible schedules Competitive pay Shift differential Health, dental, vision and life insurance benefits Company paid STD and LTD Tuition Assistance Employee Discount Program 401k Paid-time off Tuition reimbursement Non-retail/Closed-door environment Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide.
If your passion is service excellence and top-quality care come join our team and apply today! Responsibilities Communicate effectively and professionally with 3rd party entities including Pharmacy Benefit Managers (PBM's), pharmacy claim switches, and other vendors regarding claim or plan inquiries.
Understand various payer requirements and configure billing parameters within proprietary software to send online transactions to and from 3rd party insurance payers in accordance with HIPAA named standards set forth by the National Council for Prescription Drug Programs (NCPDP) Review 3rd party payer sheets for specific configuration details.
Construct telecom standard field specific templates for each payer Communicate with Switching company to construct external pre and post claim edits to prevent claim denials and ensure proper reimbursement.
Send and receive contracts on behalf of the Director of 3rd Party Network Services.
Work with Compliance team to obtain, reissue, or renew Medicaid provider ID's, and work with other internal teams across the organization.
Serve as Subject Matter Expert (SME) on cross functional work groups Provide operational support and troubleshooting to resolve both internal and external inquiries.
Research and resolve complex billing issues with available resources and tools.
This includes researching both denied and paid claim transactions, understanding root cause for denied claims or under reimbursement on paid claims, implementing methods to reduce such claims, or educating pharmacies on prevention opportunities.
Ensure all industry and/or payer related changes are communicated throughout the organization o Independently and accurately manage workload in a timely manner with minimal direction.
Communicate when competing priorities cannot be managed independently.
Prepare recurring reports related to claim denials or payments.
Query, massage, and analyze small to medium sums of claim data.
Summarize and report findings to executive management or other internal teams Support project teams in the development of functional requirements Performs other tasks as assigned.
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed above are representative of the knowledge, skill, and/or ability required.
Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Qualifications HS Diploma, GED or equivalent experience is required 2
yrs experience as a Pharmacy Technician or in a billing position within a healthcare setting is required 1
yrs experience with pharmacy or health data analysis is required 1
yrs experience working in a Pharmacy, Long Term Care or Managed Care setting is required Excellent verbal and written communication skills needed Excellent time management skills; ability to work independently and manage multiple/competing priorities required Proven ability to work with a high degree of accuracy and attention to detail Proficient in all Microsoft Word and Outlook Demonstrated analytical skills, technical knowledge and creative problem solving techniques Ability to effectively navigate ambiguous situations with limited direction Advanced analytical skills with the ability to interpret and synthesize complex data sets Able to handle high volume and significant workload Query building experience through use of Microsoft Access or other proprietary systems is a preference Familiarity with long term care pharmacy or facility billing practices is a preference About our Line of Business PharMerica is a full-service pharmacy solution providing value beyond medication.
PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.
PharMerica is one of the nation's largest pharmacy companies.
PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades.
For more information about PharMerica, please visit www.
pharmerica.
com.
Follow us on Facebook, Twitter, and LinkedIn.
Recommended Skills Analytical Attention To Detail Billing Claim Processing Creative Problem Solving Data Analysis Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
