3rd Party Plan Analyst

BrightSpring Health Services•Louisville, KY

About The Position

PharMerica, a part of Brightspring Health Services, is a long-term care pharmacy services provider that supplies medications, clinical support, and pharmacy management to healthcare organizations across the United States. As a non-retail pharmacy, we focus on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation facilities, long-term acute care centers, and other specialized care centers nationwide. Our organization is in high growth mode, which can provide opportunities for advancement for individuals looking for career progression! The 3rd Party Analyst is responsible for configuring 3rd party insurance setups within our proprietary system, and monitoring and evaluating events related to 3rd party claims. The 3rd party analyst will interact with appropriate departments to ensure integrity of third party claim information and provide pharmacy operations support. The position specializes in pharmacy claim billing and reimbursement detail. Analysts are considered experts in Medicare Part D, Medicaid, and Commercial insurance. The analyst will also assist with special projects and ad hoc assignments as needed.

Requirements

Two or more years of experience as a Pharmacy Technician or in a billing position within a Health Care setting
One or more years of experience with Pharmacy or Health Data analysis and working in a Pharmacy, long-term or managed care setting
HS Diploma, GED, or equivalent experience
Excellent verbal and written communication skills
Excellent time management skills
Ability to work independently and manage multiple/competing priorities
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

Nice To Haves

Associate or Bachelor's degree
Pharmacy Technician certification
Query building experience through use of Microsoft Access or other proprietary system
Familiarity with long term care pharmacy or facility billing practices

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
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