Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
ESSENTIAL FUNCTIONS
Provide administrative support in response to pharmacy remittance requests received from pharmacies, call center, account managers and management.
Provide first tier escalation on research and resolutions to exceptions due to overpayments or unpaid claims.
Manage moderately complex remittance issues with VA providers, state agencies and Medicaid subrogation providers, plus pharmacy chains and independents.
Correspond via mail, email, fax or phone daily with providers and vendors regarding remittance and claim status research.
Collaborate with IT, Manual Claims, Account Management, Pharma and Retail Relations on investigating and resolving underpayment/over-payment issues minimizing impact to pharmacies and clients.
Work cross functionally in the resolution and communication of remittance issues such as claims research, adjustments or pharmacy set ups.
Identify and research chain affiliation errors.
Data entry and QA of adjustments and EFT banking setup to ensure adherence on multiple remittance platforms to contract terms per Federal and State requirements, while optimizing ESI working capital.
Work with the Secure File Transfer Services (SFTS)/B2B teams to assist with the implementation and error resolution of electronic media of multiple remittance platforms.
Identify issues with electronic 835 files and request recreation of data for remittance processing.
Synchronize the setup of electronic ASCx12N 835 files with the provider, IT and B2B teams.
Resolve issues for corporate chains and independent pharmacies regarding paper, or electronic remittance requests.
Establish good working relationships with assigned electronic third-party vendors, chains, PSAO contacts.
Mentor/assist new employees with all aspects and QA work for accuracy.
Compile monthly data of completed tasks for management review to ensure department’s goals are met.
Special projects as requested by management.
QUALIFICATIONS
Must be able to work Monday-Friday with a flexible start time between 7am-8am CST
High school diploma or GED required
2+ years relevant experience preferred
Proficient in Excel and Microsoft Word
Ability to communicate professionally with all levels of company personnel and outside vendors
Strong organizational skills with the ability to meet multiple deadlines
Accurate and detail oriented in all aspects of performance
Uphold high levels of integrity in all aspects of performance
Ability to maintain confidentiality in all aspects of the work including PHI, PII and financials
Desire and ability to coach and mentor others
Desire and ability to exceed customer expectations
Provide exceptional customer service to internal and external customers
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.