Account Coordinator (Pharmacy Auditor)
About The Position
The Account Coordinator (Pharmacy Auditor) is responsible for serving Lumelight clients by participating in all aspects of our claims audit processes as well as strategically supporting the project’s kick-off through completion. This position will work closely with the rest of the Client Delivery Team, ensuring that everything we do is for the betterment of our clients. Utilizing proprietary software, this position involves reviewing pharmacy or pharmacy benefit plan documentation and provisions against actual claims paid or claims paid scenarios to identify potential issues.
Requirements
- Preferably 1 year of employment with a company; or equivalent experience in a healthcare pharmacy audit setting; or a certificate/diploma in the pharmacy field may be substituted for healthcare experience.
- Prescription Knowledge
- Proven excellence in the support and service to complex clients.
- Superior problem-solving ability, preferably within a client environment.
- Strong analytical and critical thinking ability.
- Strong ethical and professional conduct with a commitment to objectivity and confidentiality.
- Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint, etc.) and video conferencing.
Responsibilities
- Participate in all phases of the audit process and reporting to meet internal and external timeframes.
- Conduct on-site and in-house healthcare claims audits to ensure proper healthcare claim adjudication practices were followed by the third-party administrator according to client intent.
- Works with a focus to make sure the deliverables are accurate, thorough and high quality.
- Works cross-functionally Client Delivery team members (auditors, project managers) to assure service and partnership plans directly support the account plan for the client and that services are setup, maintained and delivered in the form that meets the clients’ needs and is within the scope of the contract.
- Achieve weekly commitments and assigned Individual and Team goals during applicable performance periods.
- Performs other duties as assigned.
Benefits
- Medical, Dental and Vision Benefits
- Health Savings and Flexible Spending Account Options
- 401(k) with Automatic Company Contribution
- Employee Assistance Program
- Company-paid Life and Disability Insurance
- Paid Time Off
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
