Pharmacy Reimbursement Specialist
About The Position
Overview Scope of Responsibilities : Works under minimal supervision within Accounting and Finance department to ensure timely review of data for reporting to stores, outside Third-Party Business partners, as well as government agencies. Prepares reports and maintains various files and information for the department ensuring proper reimbursement . Works collaboratively within the department to ensure licensing, credentialing and all necessary paperwork are in place for billing. Job Summary: Assists and supports the Accounting and Finance department in the achievement of Rx sales, gross margin according to plan. This is not a remote opportunity and will be in office only.
Requirements
- Previous experience in retail pharmacy, Third Party operations, and/or Finance/Accounting
- Minimum: High School Diploma or GED
- Drug Test
- Initial and continuous exclusion and sanction/disciplinary monitoring
Nice To Haves
- Preferred: AS Degree or Higher in Business Administration, or related field
Responsibilities
- Responsible for reviewing, identifying and correcting billing issues based on contractual agreements.
- Responsible for PBM related billing communications regarding better reimbursement strategies and issues faced to all locations.
- Assist in auditing plans to verify contractual compliance.
- Responsible for monitoring MAC pricing and submitting MAC appeals daily and developing and maintaining MAC reporting and analysis.
- Responsible for using daily/weekly/monthly reports for Third Party billing and pricing accuracy to maintain the highest level of profitability.
- Working with the Pharmacy Business Analyst to develop reporting as needed to gain efficiencies and improve profitability.
- Responsible for monitoring and sending claims via the AWP resubmission tool and analysis reporting of outcomes.
- Responsible for reviewing, analyzing, and developing edits internally and through our switch that can improve efficiencies and/or profitability.
- Assist Third Party Administrator/ Reimbursement Supervisor with licensing, credentialing, and Third-Party training programs.
- Assist in the development and preparation of all claims related and profitability reporting.
- Responsible for resolving Third Party pharmacy questions received from Store Systems Help Desk.
- Responsible for yearly immunization configuration, reporting and analysis.
- Assist Third Party Administrator/Reimbursement Supervisor in the review of plan set up within the pharmacy application.
- Responsible for completing all mandatory and regulatory training programs.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
