Description:
GENERAL DESCRIPTION
This position is responsible for reconciling pharmacy remittances to ensure accurate and timely payments are received.
This employee will work with insurance companies to resolve any
discrepancies and setup electronic payments and remittance files, track data to establish
patterns across payers, and assist in contracting in-house pharmacies with new and existing
insurances.
As necessary, this employee will also work with the 340B team to conduct eligibility audits.
Requirements:
ESSENTIAL DUTIES
Utilize pharmacy software to upload and reconcile remittances.
Identify any discrepancies, missing payments, etc.
and take appropriate action to correct.
Setup electronic payments and remittance files.
Track data to determine patterns and inform decisions.
Create groups for each insurance payer in the pharmacy software system in order to break data down by network.
Assist with creating detailed workflows for each of the duties within this position.
Break down and keep records of Direct and Indirect Renumeration (DIR) fees, as they relate to Medicare prescriptions.
Assist with contracting/recredentialing in-house pharmacies with various insurance companies.
Utilize electronic health records to complete 340B eligibility audits.
Performs all duties, services, and documentation in full compliance with CHC/SEK policies and procedures.
Performs other duties as assigned.
QUALIFICATIONS AND SKILLS
High school diploma or equivalent.
Computer Literacy and ability to read and comprehend written information.
Experience with Microsoft Excel preferred, but not required.
Basic math and problem-solving skills.
Must be organized and able to manage/prioritize tasks to meet deadlines, adapts to change in a positive manner, able to work as part of a team.
Able to communicate with others effectively to convey information.
Social and cultural sensitivity appropriate to ethnically and economically diverse patient-and employee-base.
WORKING CONDITIONS
While performing the duties of this job, the employee is regularly required to sit or stand; use hands to finger, handle, or feel; reach with hands and arms and talk or hear.
The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
Specific vision abilities required by this job include close vision and peripheral vision.
Computer work is frequent.
Good lighting and comfortable temperature at all times.
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