Job Title : Billing Specialist I - Pharmacy Insurance Specialist

Location : Woonsocket, RI (On-site)

Pay Rate : 20.44 $ / Hr on W2

Duration : 12 Months

Description :

• As a Pharmacy Insurance Specialist, you will be responsible for ensuring that all required third party insurance settings are coded and maintained appropriately within the pharmacy adjudication system.
• The Pharmacy Insurance Specialist will perform extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer requirements.
• As a part of the Network Operations team, this role allows you to analyze third party programs, and investigate and resolve systemic issues relative to prescription claims processing that interfaces with stores, providers, patients, pricing and financial impacts to the company.

Additional responsibilities of the Pharmacy Insurance Specialist include :

• Receiving third party program contract updates and creating or modifying third party plan configurations necessary to comply with industry standards, contract agreements and state and federal regulations
• Working with Pharmacy Application Development teams in Information Systems (IS) to provide prescription claims processing support for all system related issues or enhancements including defining business scenarios and testing procedures, analyzing production issues for any potential causes and recreating all known defects in test environments to assist development
• Working cross-functionally within the department to provide quality assurance within Pharmacy Operations by executing various scenarios affecting data quality, prescription claim processing and providing in-depth analysis of the results

Required Qualifications :

• 1 year related experience in a pharmacy, PBM, or insurance position
• 1 years of experience using Microsoft Word and Excel

Preferred Qualifications :

• Pharmacy Technician Experience
• Previous experience with business-to-business, interdepartmental, or customer interactions
• Retail Pharmacy help desk experience
• Experience with SQL or Access

Education :

Verifiable High School Diploma or GED

Position Summary :

• As a Pharmacy Insurance Specialist, you will be responsible for ensuring that all required third party insurance settings are coded and maintained appropriately within the pharmacy adjudication system.
• The Pharmacy Insurance Specialist will perform extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer requirements.
• As a part of the Network Operations team, this role allows you to analyze third party programs, and investigate and resolve systemic issues relative to prescription claims processing that interfaces with stores, providers, patients, pricing and financial impacts to the company.

Duties :

• Receiving third party program contract updates and creating or modifying third party plan configurations necessary to comply with industry standards, contract agreements and state and federal regulations
• Working cross-functionally within the department to provide quality assurance within Pharmacy Operations by executing various scenarios affecting data quality, prescription claim processing and providing in-depth analysis of the results

Experience :

Required Qualifications :

1 year related experience in a pharmacy, PBM, or insurance position

1 years of experience using Microsoft Word and Excel

Preferred Qualifications :

• Pharmacy Technician Experience
• Previous experience with business-to-business, interdepartmental, or customer interactions
• Retail Pharmacy help desk experience
• Experience with SQL or Access

Education :

A verifiable High School diploma or GED is required.

Last updated : 2024-03-25