Pharmacy Claims Auditor - Remote
Company: Prime Therapeutics
Location: Jefferson City
Posted on: November 16, 2023
|
|
|
Job Description:
Our work matters. We help people get the medicine they need to
feel better and live well. We do not lose sight of that. It fuels
our passion and drives every decision we make.
Job Posting Title
Pharmacy Claims Auditor - Remote
Job Description
The Pharmacy Claims Auditor is responsible for the selection and
auditing of claims, educating Prime's network pharmacies and
driving contract compliance, and supporting downstream claim
corrections and eliminate potential waste.
Responsibilities
Validate claim documentation and systems data to ensure claim was
accurately processed in accordance with contractual and regulatory
obligations
Solicit documentation to support pharmacy claim submission by
conducting telephonic, fax or email outreach to pharmacies
Proactively communicate and follow up with pharmacies to drive
timely and accurate documentation receipt and review
Analyze pharmacy claims to identify those at the highest risk for
error; utilize analytics and professional knowledge to select
claims or pharmacies for audit in alignment with department
procedures and objectives Educate participating pharmacies on
Prime's billing requirements and appropriate billing practices in
alignment with Prime Therapeutics' Pharmacy Provider Manual
Based on audit outcome, work directly with pharmacy or internal
partners to support accurate data and financial reimbursement to
ensure appropriate reversal or correction of claim is performed
Other duties as assigned
Minimum Qualifications
Bachelor's degree in Health Science or related area of study, or
equivalent combination of education and related work experience; HS
diploma or GED required
National Pharmacy Technician Certification through PTCB or ExCPT
(CPhT)
2 years of work experience in retail, long term care, specialty,
home infusion, or mail order pharmacy or combined pharmacy and
Pharmacy Benefit Management experience to include 1 year of work
experience in an operations, audit or quality assurance
environment
Must be eligible to work in the United States without need for work
visa or residency sponsorship
Additional Qualifications
Proficiency in MS Word, Excel, and database software
Intermediate skill and understanding of the point of sale and
on-line pharmacy claims processing environment
Excellent oral, written and interpersonal communication skills
Self-directed worker with excellent organization and analytical
skills
Ability to work effectively with a variety of audiences at all
levels of the organization
Ability to maintain confidentiality of highly sensitive
information
Professional appearance, demeanor, and conflict resolution
skills
Preferred Qualifications
3 years of previous audit experience
Current Registration with State Board of Pharmacy in the state
where position is located
Previous PBM experience
Previous 340B experience
Minimum Physical Job Requirements
Ability to work a flexible schedule including weekends, holidays,
or shifts outside of Prime's core business hours of
9:00am-4:00pm
Frequently required to sit, use hands to handle or feel, talk and
hear
Frequently required to stand, use hands to handle or feel, talk and
hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and
crouch
Occasionally required to 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, distance vision, color vision, peripheral vision, depth
perception and ability to adjust focus
Reporting Structure
To review our Benefits, Incentives and Additional Compensation,
visit our Benefits Page
(https://www.primetherapeutics.com/careers/benefits/) and click on
the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We
encourage diverse candidates to apply and all qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex (including pregnancy), sexual orientation,
gender identity or expression, genetic information, marital status,
family status, national origin, age, disability, veteran status, or
any other legally protected class under federal, state, or local
law.
Prime Therapeutics' fast-paced and dynamic work environment is
ideal for proactively addressing the constant changes in today's
health care industry. Our employees are involved, empowered, and
rewarded for their achievements. We value new ideas and work
collaboratively to provide the highest quality of care and service
to our members.
If you are looking to advance your career within a growing,
team-oriented, award-winning company, apply to Prime Therapeutics
today and start making a difference in people's lives.
Prime Therapeutics LLC is an Equal Opportunity Employer. We
encourage diverse candidates to apply and all qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, or veteran status. --- If you are an applicant
with a disability and need a reasonable accommodation for any part
of the employment process, please contact Human Resources at
1.866.469.1257 or email Careers@primetherapeutics.com.
Keywords: Prime Therapeutics, Jefferson City , Pharmacy Claims Auditor - Remote, Healthcare , Jefferson City, Missouri
|
Click
here to apply!
|
