Pharmacy Third Party Host Administrator Department Specialist III

PHARMACY THIRD PARTY HOST ADMINISTRATOR IMPLEMENTATION

CORPORATE PHARMACY – BOISE, ID

The Corporate Pharmacy Department, located in the Boise Corporate Offices in Boise, Idaho has an opening for a Third Party Host Administrator.

Position Purpose:

The Third Party Host Administrator is responsible for maintaining Third Party billing setup for multiple pharmacy systems (ARX, EPS and PDX) software which enables pharmacies to transmit compliant claims. The Administrator will responsible for completing the necessary enrollment documentation for multiple State Medicaid Agencies in order to bill pharmacy and Durable Medical Equipment claims. They assist the Managed Care Manager(s) on improving cost containment policies and compliance goals.

Key Responsibilities include, but are not limited to:

•Inputting third party plan data elements in ARX, EPS, and PDX software systems ensuring compliance to HIPAA and National Council for Prescription Drug Programs standards 

•Provide level II pharmacy systems support, serving as technical third party plan lead for help desk coordinators.

•Submit test claims for processor certification requirements.

•Work with Managed Care Department Specialists to ensure that the all host third party records are up-to-date and properly distributed to stores.

•Communicate to pharmacies all facts related to claim processing for successful Third Party Billing.

•Provide support to Manager, Managed HealthCare for ARX, EPS, and PDX software for enhancements that improve cost containment policies and compliance goals.

•Communicates with IT Service Desk, Account Receivables, Pharmacy Operations and Pharmacy System Vendors (Pharmacy Benefit Managers) in order to maintain continuity, and compliant reimbursement/profitability. 

•Provide Third Party claim data for analysis to support third party negotiations.

•Create reports and run data analysis to support Managed Care Department reimbursement efforts and compliance. 

•A limited amount of travel will be required. 10%

Qualifications:

•Preferred pharmacy experience including managed care and third party billing

•Preferred knowledge of pharmacy systems software, i.e. ARx, EPS, and/or PDX

•Knowledge of Pharmacy Benefit Managers.

•Knowledge of NCPDP Standards and Federal & State legislation affecting pharmacy trends.

•Proficient in Microsoft Office (Outlook, Excel, Word, Access).

•Excellent written and oral communication skills.

•Outstanding customer services skills

•Problem solver

•Ability to multi-task with strong attention to detail.

•Self-starter, able to work with minimum supervision.

Physical Environment:

•Most work is performed in a temperature-controlled office environment.

•Ability to sit for long periods at desk or computer.

•Will use calculators, keyboards, telephone, and other office equipment.

•Stooping, bending, twisting, and reaching may be required in completion of job duties.

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.  EOE