Claims Processing Coordinator (Department Specialist II)
Job Responsibility:
· Handles a variety of complex duties related to auditing Third Party claims via POS and compliance related system functionality thru our In-House processing system (RxView-ProIntercept Software and Vendor PPE System)
· Initiate and identify new ways to maximize margin via editing and special requests for RxView System enhancements and Vendor PPE System
· Extensive analysis and review of reports associated with contracted rates and editing for pharmacy compliance
· Support, Review and identification of legal & audit risks that may occur during claims processing
· Support pharmacy processing issues and address recurring processing problems.
Education/Experience:
· H.S. Diploma
· Pharmacy Technician with ARx experience required
· Third Party experience
Skills/Knowledge Requirement:
· Excellent PC skills – Microsoft Office, Excel, Access, Outlook etc.
· Ability to work in a team environment and adapt easily to constant change
· Math skills at a proficient level -work well with numbers and percents
· Handle multiple open tasks
· Strong communication skills-written and verbal
· Ability to manage time efficiently and stay organized
· Well organized
· Strong decision making abilities
· Detail oriented
Physical Environment:
· Most work is performed in a temperature-controlled office environment
· Incumbent may sit for long periods of time at desk or computer terminal
· Incumbent may use calculators, keyboards, telephone, and other office equipment in the course of normal workday
The above statements are intended to describe the general nature of the work performed by the employees assigned to this job. All employees must comply with Company policy and applicable laws. The responsibilities, duties and skills required of personnel so classified may vary within each department and/or location.