BrightSpring Health Services

3RD PARTY ANALYST

Job Locations US-MA-TAUNTON
ID
2021-27528
Position Type
Full-Time
Line of Business
PharMerica

Our Company

PharMerica Logo_1250x667

Overview

Are you the super-star multitasker type, strong in administration skills? Our Administrative and Clerical positions support the business from multiple locations and via various functions across the nation. Read below for information on this opportunity and apply today!

 

Responsibilities

• Communicate effectively and professionally with 3rd party entities including Pharmacy Benefit Managers (PBM’s), pharmacy claim switches, and other vendors regarding claim or plan inquiries.
• Understand various payer requirements and configure billing parameters within proprietary software to send online transactions to and from 3rd party insurance payers in accordance with HIPAA named standards set forth by the National Council for Prescription Drug Programs (NCPDP)
• Review 3rd party payer sheets for specific configuration details. Construct telecom standard field specific templates for each payer
• Communicate with Switching company to construct external pre and post claim edits to prevent claim denials and ensure proper reimbursement.
• Send and receive contracts on behalf of the Director of 3rd Party Network Services. Work with Compliance team to obtain, reissue, or renew Medicaid provider ID’s, and work with other internal teams across the organization.
• Serve as Subject Matter Expert (SME) on cross functional work groups
• Provide operational support and troubleshooting to resolve both internal and external inquiries.
• Research and resolve complex billing issues with available resources and tools. This includes researching both denied and paid claim transactions, understanding root cause for denied claims or under reimbursement on paid claims, implementing methods to reduce such claims, or educating pharmacies on prevention opportunities.
• Ensure all industry and/or payer related changes are communicated throughout the organization
• Independently and accurately manage workload in a timely manner with minimal direction. Communicate when competing priorities cannot be managed independently.
• Prepare recurring reports related to claim denials or payments.
• Query, massage, and analyze small to medium sums of claim data. Summarize and report findings to executive management or other internal teams
• Support project teams in the development of functional requirements
• Performs other tasks as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

Education/Learning Experience
• Required: HS Diploma, GED or equivalent experience
• Desired: Associate or Bachelor’s degree
Work Experience
• Required: 2+ yrs experience as a Pharmacy Technician or in a billing position within a healthcare setting
• Required: 1+ yrs experience with pharmacy or health data analysis
• Required: 1+ yrs experience working in a Pharmacy, Long Term Care or Managed Care setting
Skills/Knowledge
• Required: Excellent verbal and written communication skills
• Required: Excellent time management skills; ability to work independently and manage multiple/competing priorities
• Required: Proven ability to work with a high degree of accuracy and attention to detail
• Required: Proficient in all Microsoft Word and Outlook
• Required: Demonstrated analytical skills, technical knowledge and creative problem solving techniques
o Required: Ability to effectively navigate ambiguous situations with limited direction
o Required: Advanced analytical skills with the ability to interpret and synthesize complex data sets
o Required: Able to handle high volume and significant workload
• Desired: Query building experience through use of Microsoft Access or other proprietary systems
• Desired: Familiarity with long term care pharmacy or facility billing practices.

About our Line of Business

PharMerica is a full-service pharmacy solution providing value beyond medication.  PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.  PharMerica is one of the nation's largest pharmacy companies.  PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades.  For more information about PharMerica, please visit www.pharmerica.com.  Follow us on FacebookTwitter, and LinkedIn.

Additional Job Information

Must be available to work 8:30-5 pm.

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