Pharmacy Reimbursement Specialist

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

This is not a remote opportunity and will be in office only.

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.
• Aid 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.
• Work 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.
• Aid Third Party Administrator/Reimbursement Supervisor with licensing, credentialing, and Third-Party training programs.
• Aid in the development and preparation of all claims related and profitability reporting.
• Resolve Third Party pharmacy questions received from Store Systems Help Desk.
• Aid in the review of plan set up within the pharmacy application.
• Complete all mandatory and regulatory training programs.
• Perform other duties as assigned.

Qualifications

• Experience: Previous experience in retail pharmacy, Third Party operations, and/or Finance/Accounting preferred.
• Educational Requirements: Minimum: High School Diploma or GED, Preferred: AS Degree or Higher in Business Administration, or related field.

Special Conditions Of Employment

• Drug Test
• Initial and continuous exclusion and sanction/disciplinary monitoring

Compensation

$18.50 - $21.00 per hour. The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.